The vocal cords adduct (or come together) and a precise sequence of muscular contraction occurs each time we swallow. If a person develops difficulty with the vocal cords or structures in the larynx (voice box), swallowing may be impaired.

Common indications of a swallowing disorder include:

• Coughing or throat clearing after sips of liquid or bites of food
• Wet, gurgly vocal quality after swallowing
• Feeling of foods getting “stuck” when swallowing

Swallowing disorders can be broken down into two main origins:

• Oropharyngeal dysphagia: Any problem in swallowing resulting from impairment in the sensation, coordination, or strength of the muscles in the mouth, throat, and larynx (voice box). Aspiration (entry of food, liquid, saliva, etc. into the trachea) can occur and lead to pneumonia and malnutrition.
• Esophageal dysphagia: Any problem with transit or motility/movement of food/liquid from the food tube or esophagus, or any problem with food/liquid coming back into the esophagus from the stomach.

Evaluation

Evaluation may involve a barium swallowing evaluation, a modified barium swallowing evaluation, and/or a fiberoptic endoscopic evaluation of swallowing.

An otolaryngologist and speech pathologist will evaluate the specific function of swallowing, determine the causes, and provide a treatment plan to meet your goals (and provide safety and comfort with swallowing).

Treatment

Treatment may consist of a combination of swallowing therapy, medical management, and/or surgical management. Many swallowing disorders do not require surgery.

Swallowing exercises are often given by the speech pathologist to address strengthening and coordination of swallowing musculature. Compensatory swallowing strategies may be provided as well. Neuromuscular electrical stimulation may be recommended along with swallowing treatment.

Zenker's Diverticulum

Zenker’s diverticulum is a pouch that forms at the back of the throat at the junction of the pharynx and the esophagus (the food passage to the stomach).

See Zenker's Diverticulum for diagnosis and treatment details.

Physicians

Physicians offering this service include:

• Cohen, Seth M.
• Scher, Richard L.
• Witsell, David L.

Locations

This service is available at:

• Duke Otolaryngology, Head and Neck, ENT
  Duke Clinic 1H, Purple Zone, 200 Trent Drive, Durham, NC 27710