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Getting A Grip On Swallowing Problems

By Roya Sayadi, Ph.D., CCC-SLP and Joel Herskowitz, M.D.

(Page 3 of 4)
  • “It hurts when I swallow.”

  • “I’m afraid I’m going to choke.”

  • “My voice sounds funny after I eat.”

  • “I get so tired, I can’t finish a meal.”

  • ““What do you expect? I’m old.”

Sometimes, however, a person has no complaint at all – but a very real problem with swallowing.

Where Swallowing Breaks Down

To understand how things can go wrong with swallowing, let’s look briefly at normal swallowing. 

Swallowing is a process – a set of steps that takes food (or liquid or pills) from mouth to stomach.

  1. CHEWING (which, of course, does not apply to liquids). The tongue, lips, cheeks, jaw, and teeth work together to reduce food to a pasty ball. Saliva plays a key role. It glues together the ground-up food, gathering up flaky bits so they don’t tickle your throat or get sucked into your lungs.

    When jaw muscles are weak, teeth are missing, or dentures are loose or painful, chewing will be impaired. That can set the stage for a choking emergency.

  2. TRANSPORTING the food from mouth to throat. The tongue acts like a bucket without a handle. Cancer surgery, neurologic disorders (such as stroke, MS, ALS, or Parkinson’s disease), or dehydration can interfere with moving the food along.

  3. SWALLOWING itself. This is a reflex triggered by food or liquid getting to where the tonsils are (or used to be). Several things happen pretty much at once to make sure food goes into the esophagus, not into the windpipe.

    When muscles are weak (as with muscular dystrophy or myasthenia gravis) or nerve signals are scrambled or absent (as with stroke, MS, or ALS), the reflex cannot provide for safe swallowing.

  4. THE ESOPHAGUS. Muscles at its beginning and end act like traffic cops. One-way travel only! Otherwise, you pay the price with heartburn, bad breath, or worse.

    Connective tissue disorders like scleroderma can constrict the esophagus and prevent proper movement of food or liquid. Chronic reflux of acidic stomach contents (as with GERD) can irritate the lining of the esophagus and cause it to stick together, preventing food from getting to the stomach.

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