Swallowing Disorders

New dysphagia requires a careful assessment to make an accurate diagnosis, as there may be many causes. The most important thing however, is to exclude a cancerous growth in the swallowing apparatus or on the nerves that supply them.

Because swallowing is a complex coordination of muscles and nerves, many conditions can interfere. Causes fall broadly into oropharyngeal (mouth/throat) and oesophageal (gullet) categories.

Oropharyngeal (throat) causes

• neurological diseases, such as Parkinson’s disease, multiple sclerosis, stroke, and motor neuron disease

• muscle disorders, including myasthenia gravis and muscular dystrophies

• injury, scarring, or structural lesions of the throat

• weakness of the tongue or throat muscles

• post-surgical changes to the neck, throat, or larynx

Oesophageal causes

• oesophageal strictures (scar narrowing)

• oesophageal rings or webs

• gastro-oesophageal reflux disease (GORD) leading to inflammation or scarring

• post-radiotherapy changes

• external compression, such as an enlarged thyroid gland or cervical bone spurs

• pharyngeal pouch (Zenker’s diverticulum)

• motility disorders, such as achalasia and diffuse oesophageal spasm

Globus sensation (“lump in throat”)

Some patients describe a persistent sensation of a lump or foreign body in the throat (globus) despite normal swallow function. This is usually benign but should be investigated.

At Welbeck, our ENT specialists take a structured approach to the diagnosis of swallowing disorders. This helps them to accurately identify the cause and guide the best possible treatment.

At an initial consultation, your consultant will take a medical history, and will ask you about the onset, progression, and symptoms you're experiencing. They will also:

• examine your neck and throat

• use swallowing questionnaires

• perform a neurological examination and assessment of speech and swallowing

Other tests that may be required to make an accurate diagnosis include:

• flexible endoscopic evaluation of swallowing (FEES) to view the pharynx and larynx during swallowing

• video-fluoroscopic swallow study (VFSS) — dynamic X-ray of swallowing

• transnasal oesophagoscopy (TNO) or flexible nasoendoscopy for direct inspection

• endoscopy (OGD) to visualise the oesophagus and stomach and take biopsies if needed

• barium swallow for structural assessment of the pharynx and oesophagus

• CT or MRI where neurological causes or deep structural disease are suspected

In many cases, the consultant will combine clinical judgement with test results to plan treatment and follow-up.

Not all causes of dysphagia are preventable, but several practical steps may reduce your risk of developing problems or of their worsening. Early identification and simple changes often make a meaningful difference.

• eat slowly and take small bites to make chewing easier

• chew food thoroughly and put down cutlery between mouthfuls to pace eating

• remain upright while eating and for at least 30 minutes afterwards to reduce reflux and aspiration risk

• avoid alcohol and sedating medications around mealtimes to preserve effective swallowing reflexes

• stay well hydrated to reduce thick saliva and mouth dryness

• maintain good oral hygiene and regular dental care to reduce the risk of chest infections from oral bacteria

• manage reflux/GORD with lifestyle measures (avoid large late meals, elevate head of bed, lose weight where appropriate) and medical treatment if advised by a clinician

• review medications that cause dry mouth or sedation with your GP or specialist, and consider alternatives where possible

• stop smoking and avoid excessive alcohol to help the cough reflex and general throat health

• if you have a neurological condition or known swallowing difficulty, work with a speech and language therapist for tailored exercises, swallowing strategies and a safe-eating plan

• ensure routine vaccinations (influenza and pneumococcal) if you are at higher risk of chest infection

Some causes, for example, neurological disease or anatomical problems, cannot always be prevented, but early recognition, rehabilitation and specialist review can reduce complications and improve outcomes.

If left unrecognised or untreated, swallowing problems can lead to complications, such as:

• aspiration of food or liquids into the lungs, potentially causing pneumonia

• dehydration and poor nutrition leading to weight loss and reduced strength

• social isolation and reduced quality of life from eating difficulties

• need for feeding support, such as nasogastric or PEG feeding, in severe cases

Most complications are preventable or manageable when a multidisciplinary plan is in place.

Medical and surgical management will usually be directed at the underlying diagnosis, as well as encompassing dietary and lifestyle modifications to improve exacerbating factors such as dry mouth or GORD.

Complex dysphagia requires collaborative work with a speech and swallow therapist. Our specialists will develop an individualised programme of exercises designed to help your swallow, aiming to divert food away from the airway in an aspirating larynx, strengthen the tongue musculature and the external muscles that surround the throat, and provide strategies to clear food and fluid that may have entered the larynx.

Treatment depends on the underlying cause and the severity of symptoms. A combined approach between ENT, speech therapy, gastroenterology and neurology often gives the best results.

Treatment options include:

• swallowing rehabilitation with a speech and language therapist focusing on exercises, positioning and safe-swallow techniques

• dietary modification and texture adaptation under professional guidance

• medical treatment of reflux, infection, or inflammation

• botulinum toxin injection for cricopharyngeal dysfunction

• balloon dilation of strictures or narrowed segments of the oesophagus

• endoscopic or open surgical procedures for structural problems such as pharyngeal pouch or persistent cricopharyngeal bar

• vocal cord medialisation or injection for swallowing problems related to vocal cord palsy

• long-term enteral feeding (nasogastric or PEG) in selected patients to protect airway and nutrition while underlying issues are treated

Your consultant will discuss risks and benefits and tailor a plan to your needs and overall health.

At Welbeck, our ENT specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.

What should I bring to my first appointment?

Bring a list of current medications, any GP or hospital letters, details of foods or situations that trigger problems, and any previous test results or imaging you have.

Who will be involved in my care?

Your team may include an ENT consultant, speech and language therapist, gastroenterologist, and neurologist or dietitian as needed for a coordinated treatment plan.

Will my private health insurance usually cover investigations and treatment?

Many insurers cover specialist consultations and common tests, but coverage varies by policy. Check with your insurer about preauthorisation and specific inclusions.

How will swallowing problems be monitored over time?

Monitoring typically includes follow-up consultations, repeat tests if symptoms change, nutrition checks, and ongoing speech therapy assessment to adapt the care plan.