Dysphagia, commonly known as difficulty swallowing, is a symptom that can occur due to the existence of various diseases that affect the upper aerodigestive tract. Swallowing is a complex process that involves the smooth coordination of multiple structures in the head and neck. It includes three phases: oral, pharyngeal and esophageal. The oral phase involves the preparation and transport of food to the pharynx. The pharyngeal phase involves the passage of food from the pharynx to the esophagus, while the esophageal phase involves the movement of food to the stomach. The coordinated function of the tongue, soft palate, pharynx, larynx and esophagus is vital for the smooth completion of swallowing.
What causes dysphagia?
Dysphagia can be due to various and heterogeneous causes. Initially, inflammatory conditions such as pharyngitis, tonsillitis and epiglottitis can cause swelling and pain, leading to difficulty swallowing. Also, benign or malignant tumors in the oropharynx, hypopharynx, larynx, or esophagus can block the passage of food, causing dysphagia. An abscess or neoplasm of the cervix may manifest itself with difficulty in swallowing. Dysphagia may additionally be due to ingestion of foreign bodies, especially if the patient is an infant. Finally, additional conditions such as tonsillitis, acicular ligament syndrome, or a long acicular process contribute to the manifestation of this unpleasant symptom.
Injuries to the head, neck, or esophagus from accidents or surgery can cause structural damage that leads to dysphagia. In several cases, dysphagia may also be due to some neuromuscular disorder. Initially, this symptom may be due to neuralgia of the glossopharyngeal nerve. At the same time, the neuromuscular disorders that are most likely to cause difficulty in swallowing include:
- Stroke.
- Parkinson’s disease.
- Myasthenia gravis.
- Amyotrophic Lateral Sclerosis.
What treatment options are available?
Each condition of otorhinolaryngological origin that causes difficulty in swallowing is treated in a different way. Inflammatory conditions such as tonsillitis or pharyngitis are generally treated with antibiotic treatment, which reduces inflammation and swelling.
In cases of recurrent tonsillitis, tonsillectomy, the surgical removal of the tonsils, may be indicated. Viral pharyngitis, which is self-limiting, resolves with hydration, analgesics, and antipyretics. Epiglottitis, on the other hand, requires immediate medical attention with intravenous antibiotics initially, while corticosteroids may also be administered to reduce inflammation.
If the difficulty in swallowing is due to a tumor in the oropharynx, hypopharynx, larynx, or esophagus, the appropriate treatment depends on whether the tumor is benign or malignant. For benign tumors, surgical resection is the only treatment needed and can be performed endoscopically or through open surgical techniques, depending on the size and location of the tumor. Malignant tumors require a more complex approach, often involving a combination of surgery, radiation therapy, and chemotherapy. Surgical removal of also benign or malignant tumors in the head and neck region can relieve obstructive dysphagia.
Treatment of a cervical abscess initially involves administration of broad-spectrum intravenous antibiotics, while surgical drainage is often necessary. Benign neoplasms are usually treated with surgical excision. Malignant neoplasms require a more comprehensive approach, including surgical resection followed by adjuvant treatments such as radiation or chemotherapy.
Swallowing a foreign body, on the other hand, is treated based on the size, type, location of the object, and the potential for complications. Usually, its endoscopic removal is the preferred method. The procedure is performed with either a flexible or rigid endoscope, depending on the location of the object and the condition of the patient. For sharp or elongated objects such as fish bones or toothpicks, extreme care in removing them is necessary to avoid injury.
Dysphagia is a complex symptom with multiple etiologies, particularly in the field of otorhinolaryngology. Understanding the various otolaryngological causes and the corresponding management options is vital for the effective resolution of this unpleasant symptom. ENT Surgeon in Athens Dr. Olga Papadopoulou investigates whether dysphagia is actually due to an otorhinolaryngological cause. If it is found that the difficulty in swallowing does have such an origin, a completely individualized treatment plan is implemented on a case-by-case basis.