Swallowing is a highly complex process that needs all the muscles and nerves to work in the correct sequence and be strong enough to push the food and drink down from the mouth the the stomach.
There are many things that interfere with the ability to swallow some of them are simple mechanical issues like a narrowing of the gullet and others highly complex neurological problems as a result of underlying disease. The most important first step when assessing swallowing is to work out where in this complex process the problem lies. This may be apparent after taking the history and some simple investigations like a nasendoscopy. Other tests may be required which vary from a barium swallow to 24hr monitoring of the pressure in the oesophagus. Sometimes the swallowing problem can be easily fixed with surgery or Btx injection other times it is not possible to cure the problem and it will need to be managed with a variety of techniques and adjustment to the diet. This is normally overseen by the speech therapy team.
The cricopharyngeus muscle is a muscle at the top of the gullet that opens and closes to allow food down into the oesophagus and stops the stomach contents coming back into the throat. In certain circumstances the muscle fails to open and this makes swallowing difficult. Some patients will cope well with changing the consistency of their diet but in other patients the narrowing is too bad and they are unable to swallow anything solid at all. This causes the patient to lose weight, take an extremely long time to eat and may also get chest infections due to food spilling into the voice box and going down into the lungs.
We have to ensure the cricopharyngeus is the cause of the problem. This is usually done with a specialist x ray called a videofluroscopy. Once the cause is established the problem can be treated with botulinim toxin injections. Some patients want the injections for globus sensation- intermittent spasm causing a feeling of a lump in the throat. Unfortunately this usually does not work and relaxation techniques are more effective.