The vocal cords close (or come together) each time we swallow so that food and liquid do not enter our trachea (windpipe) and lungs.

If a person develops difficulty with the vocal cords or structures in the larynx (voice box), swallowing may be impaired. Sometimes this difficulty is related to muscle weakness, loss of sensation, or incoordination with the swallowing muscles.

Common signs of a swallowing disorder include:

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

Swallowing disorders can be broken down into two main origins -- oropharyngeal or esophageal:

• 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 movement of food or liquid from the food tube or esophagus, or any problem with food/liquid coming back into the esophagus from the stomach.

Some people have both forms of dysphagia.

The consequences of a swallowing problem may range from mild to serious complications. One person may have mild discomfort with swallowing while another person develops a pneumonia from food or liquid entering the lungs.

The Duke Voice Care Center doctors and speech pathologists can educate you about your risks and assist you in determining the best treatment plan for your swallowing symptoms.

Evaluation

Evaluation may include one of the following swallowing tests:

• Barium swallowing evaluation to test the esophageal phase of swallowing
• Modified barium swallowing evaluation (sometimes called videofluoroscopic) to test the oropharyngeal phases of swallowing
• Fiberoptic endoscopic evaluation of swallowing (FEES) to evaluate oropharyngeal 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).

Your treatment plan may involve changing the consistency of the foods or liquids you swallow. For example, adding a thickening agent may make swallowing liquids safer for you.

While some people may experience chronic difficulties with swallowing, there are many times where dysphagia is a temporary problem which improves. The improvement will depend on the cause of the swallowing difficulty, and the DVCC team can assist you in understanding your specific course of treatment.

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.

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.

Appointments with Swallowing Specialists

Call 919-684-3834 (local) or 800-385-3646 (toll-free) to make an appointment with a swallowing specialist in the Triangle of North Carolina. We see patients from Durham, Raleigh, Cary, Chapel Hill, and beyond. Learn more about appointments with Duke Voice Care Center specialists.

Speech Pathologists

• Banka, Caroline
• Bartholomew, Hilary
• Vess, Gina

Physicians

Physicians offering this service include:

• Cohen, Seth M.
  • Surgery / Otolaryngology-Head and Neck Surgery
• Raynor, Eileen M.
  • Surgery / Otolaryngology-Head and Neck Surgery
  • Pediatrics / Pediatrics-Chairman Office
• Scher, Richard L.
  • Surgery / Otolaryngology-Head and Neck Surgery
• Witsell, David L.
  • Surgery / Otolaryngology-Head and Neck Surgery

Locations

This service is available at:

• Duke Otolaryngology of Raleigh
  Duke Medicine Plaza, 3480 Wake Forest Road, Suite 404, Raleigh, NC 27609
• Duke Otolaryngology, Head and Neck, ENT
  Duke Clinic 1F, Yellow Zone, 40 Duke Medicine Circle, Durham, NC 27710