Causes

There is a wide range of possible causes for swallowing problems. The causes can be divided into several different groups: High, or low age, drug treatment, nerve and consecutive muscle loss, dislocation due to foreign bodies, and physiological constrictions that affect the transport of the food pulp. Both high and low age are influencing factors for swallowing difficulties.

In old age, not only muscles but also receptors and nerves slacken. Stimulation is transmitted less well and the swallowing process is triggered less well than before. It is no exception that older patients have less appetite than before.

Food no longer tastes and smells as good as before, and therefore no longer represents a major stimulus. In addition, artificial teeth, pain in the mouth area, and frequent swallowing can make eating unattractive. But swallowing difficulties can also affect food intake in infancy or childhood.

While the cause in older patients is usually due to “environmental variables”, infants sometimes have not yet learned or never really learned the correct swallowing process. Both can lead to swallowing difficulties. Another reason for swallowing difficulties, which particularly affect patients with mental disorders, is drug treatment.

Neuroleptics – i.e. “nerve-soothing drugs” – are drugs that are used to treat mental disorders such as delusion, schizophrenia, and general states of arousal. One divides typical and atypical neuroleptics, whereby the “typical” ones belong to the somewhat older class of drugs. These drugs cause so-called “extrapyramidal disorders”, i.e. disorders in which the swallowing process is impaired.

The pyramidal pathway is a nerve pathway containing nerve fibers for voluntary, i.e. deliberately influenced motor functions. It can also be damaged during a stroke. Extra-pyramidal disorders are disorders of the involuntary motor function, whose actual task is to control the pyramidal tract.

It is also responsible for involuntary, automated processes, such as the swallowing process. However, various typical neuroleptics impair the function of the extrapyramidal nerve tracts. After taking the drugs, the patient then notices that swallowing is no longer as easy as it used to be, swallowing is more frequent, and sometimes even mouth and tongue cramps occur.

Therefore a correct dosage of the typical neuroleptics is important. Out of this need, efforts were made to develop neuroleptics that cause less severe extrapyramidal side effects and the “atypical” neuroleptics were introduced to the market. Their most famous representative is clozapine.

In fact, it has been shown to reduce spasms of the throat and tongue, but they are not equally well tolerated by all patients and have a different, no less severe spectrum of side effects. Like any other movement of the body, swallowing requires a large number of muscles: On the one hand, the pharynx is contracted via the pharyngeal laces, on the other hand, the laryngeal flap is pressed onto the esophagus. Finally, the food pulp must be actively pushed into the esophagus, a muscle tube about 40 centimeters long.

This makes it clear what a fine interplay of several muscles the swallowing process represents. If one muscle fails, this can usually still be compensated by the remaining muscles, but if several muscles are damaged, this results in swallowing difficulties or the inability to perform the swallowing process. This can be the case, for example, in the course of a stroke.

Parts of the brain are damaged and the motor areas are often affected. Certain nerve fibers move from the brain to the muscles of the pharynx, and are “paralyzed” after a stroke. It is not without reason that the emergency service looks at the suppository in the mouth in suspected cases to compress or weaken any indications of a stroke.

However, nerve tracts and muscles can also be damaged after operations or through tumorous infiltration. In addition to swallowing difficulties, an absolute warning signal for a stroke is a “blurred”, unclear speech.Swallowing difficulties can also be caused by a foreign body. The first thing that comes to mind is a small child who has swallowed a toy.

However, there is a wide variety of causes for swallowing problems in adulthood, which are caused by foreign bodies in the neck and throat area. One of these causes is the so-called “Zenker diverticulum”. This is the name given to a bulge in the wall of the esophagus, with the formation of a small cavity which from then on attaches to the esophagus.

Along the esophagus there are three narrowing points. The first is located about 15 centimeters behind the row of teeth, in the neck area. If the pressure at this point is permanently too high, it will lead to sacculation.

In this pocket, food remains accumulate with each intake of food, which lead to swallowing, coughing, and above all swallowing difficulties. In addition to these symptoms, there is often unpleasant bad breath, and a feeling of pressure and lumps in the throat. But also tonsillitis, or infiltrating tumors in the throat area can affect the swallowing process.

At home the first clarification can already be done: With the help of a hand mirror and a flashlight (often a cell phone also has an appropriate light source), one can shine astonishingly far into the mouth and throat area. You don’t have to be an ENT specialist to find out that something looks “not normal”, often the side comparison between the right and left side of the neck gives you a clue. In case of suspicion, however, a further examination is of course carried out by a specialist.

As already mentioned, on the way from the mouth to the stomach there are three physiological, i.e. natural, constrictions that the food pulp has to pass through. The first constriction often leads to the development of diverticula. The second constriction is located directly behind the heart, and can typically cause retrosternal pain.

Understandably, sufferers are often afraid that it could be a heart problem. This is because the esophagus runs directly along the left atrium of the heart. At this narrow point, which is a good 25 cm behind the row of teeth, there is often a feeling of pressure in the depth of the chest, which makes many think of a heart attack.

However, this is a gastrointestinal problem. A heart attack would also tend to announce itself more likely with radiating pain in the left arm. This form of symptoms often leads to severe heartburn, belching, difficulty swallowing, and even vomiting undigested food – a very unpleasant condition for the patient in the long run.

However, it is relatively easy to clarify the situation with a gastroenterologist, who will then initiate appropriate therapy. A whole range of diseases can be listed as causes of swallowing difficulties. In addition to inflammatory processes of the mouth and throat, these include neurological diseases and psychological disorders.

In some cases, however, problems in the area of the cervical spine are also the cause. These are often summarized under the generic term of the cervical spine syndrome. In addition to the consequences of whiplash or a herniated disc, this also includes functional tension of the neck muscles.

These can cause a wide range of symptoms such as neck and throat pain, swallowing difficulties, dizziness, headaches, as well as visual disturbances and ringing in the ears. A therapy of these tensions is often protracted, as it is based on chronic processes. It must also be tailored to the individual patient to be as effective as possible.

As a rule, so-called multimodal therapy approaches are used for the cervical spine syndrome. In short, this is a form of therapy in which different treatment methods are combined with each other. Both drug-based pain and muscle relaxation therapy as well as physiotherapy play an important role here.

In addition, treatment methods such as heat therapy can be helpful. Inflammation of the palatal tonsils (angina tonsillaris-tonsillitis) is one of the most common causes of swallowing problems. Usually harmless viruses (especially rhinoviruses and adenoviruses) are found as triggers in flu-like infections.

Typical symptoms such as sore throat, rhinitis, cough and/or swallowing difficulties are the result. Sometimes, however, a real flu can also be the cause of swallowing difficulties. This can lead to similar, but much more pronounced symptoms, as well as a sudden rise in fever and aching limbs.However, bacteria can also be responsible for an inflammation of the tonsils.

These are mainly Group A Streptococci. These are transmitted with saliva by droplet infection, i.e. by sneezing, coughing and kissing, and multiply in the lymphatic tissues such as the palate or pharyngeal tonsils when the immune system is weakened. Children and young people are particularly affected.

Treatment, if necessary, usually takes the form of drug-based pain therapy (e.g. with ibuprofen or paracetamol) and the administration of an antibiotic (e.g. penicillin). In combination with bed rest, tonsillitis is usually well manageable and will subside within a few days if the antibiotic is taken consistently.