Swallowing Disorders

Swallowing Disorders

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Duke specialists use sophisticated diagnostic techniques and the latest medical advances to treat people who have difficulty swallowing, a condition known as dysphagia. Swallowing disorders may result from a variety of medical conditions including:

People with cleft lip and palate, achalasia, Zenker’s diverticulum, voice disorders, or throat cancer may also need care from specialists trained to treat swallowing disorders.

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Expert Care for Swallowing Disorders

Swallowing disorders can make it difficult for you to drink liquids without choking, or cause you to feel like food is stuck in your throat. You may experience frequent coughing or gagging while eating. Swallowing problems can lead to:

  • Aspiration pneumonia (an inflammation of your lungs and bronchial tubes caused by a foreign object)
  • Upper respiratory infections
  • Weight loss
  • Acid reflux
  • Regurgitation of undigested food
  • Painful swallowing

Regardless of your symptoms, we have the expertise and resources to identify what's wrong and help you eat and drink safely and comfortably, without fear of choking

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Duke Health offers locations throughout the Triangle. Find one near you.


Rehabilitative Swallowing Exercises

A personalized program designed to strengthen your swallowing muscles, prevent choking or gagging, and increase sensation in your mouth and throat for speedier, safer, and more satisfying swallowing.

Compensatory Swallowing Techniques

These are techniques that can make eating easier and safer, such as swallowing liquids after solids to wash food down your throat or changing the position of your head and neck when eating.

Medical Management

May include dietary changes, such as adding a thickening agent to make liquids easier to swallow, as well as lifestyle changes such as weight loss and sleep positioning. Medications may be prescribed to reduce acid production and relax the esophageal muscles. Antibiotics may be prescribed for esophageal infections.

Esophageal Dilation

A balloon-tipped tube is passed through your mouth and into your esophagus. The balloon is then inflated to stretch narrowed areas that impede swallowing. This is performed as an outpatient procedure under local anesthesia.


Botulinum toxin, or Botox, is used to treat certain swallowing problems. It works by relaxing the upper esophageal sphincter, a muscular valve between the esophagus and throat.


Surgery is used to treat a wide range of esophageal and throat disorders that impair swallowing, including GERD, vocal cord paralysis, and Zenker’s diverticulum. We use minimally invasive techniques, which typically heal faster and with less discomfort than traditional surgery. No skin incisions are needed because surgery is performed through the mouth.

POEM for Achalasia

A less-invasive procedure called per-oral endoscopic myotomy (POEM) helps people with achalasia eat and drink comfortably again. A flexible, lighted tube called an endoscope is passed through the mouth and into the esophagus, allowing doctors to see and treat the damaged muscles that cause the swallowing disorder, without the need for surgical incisions.

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Swallow Evaluation

This assessment uses a combination of asking questions about your symptoms, checking the strength of your swallowing muscles, and observing you swallow various foods and liquids to assess for signs of swallowing difficulty.

Fiberoptic Endoscopic Evaluation of Swallowing

A flexible endoscope (a small camera with a light) is passed through your nose to view your throat while you swallow brightly colored foods and liquids. You may be asked to try different swallowing positions, such as tilting your head or tucking your chin, to see which work best.

Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing

Fiberoptic endoscopic evaluation of swallowing is combined with an additional test in which an endoscope delivers small puffs of air to various areas of your throat to check how well it detects sensations from a foreign body. The air puffs should trigger a protective airway reflex (tightening of certain structures in the throat to avoid aspirating food).

Videofluoroscopic Swallow Study

Video X-rays visualize your mouth, throat, and upper esophagus as you swallow foods and drinks of different textures and consistencies, mixed with barium (a liquid visible on X-rays). Evaluates your swallowing process, whether food or liquid is entering your airway (aspiration), which types of food are easiest for you to swallow, and which positions make it easier for you to eat safely.

High-Resolution Manometry/pH-Impedance Testing

A tube containing sensors is passed through your nose into your esophagus to measure muscle contractions when you swallow and evaluate how efficiently food is propelled to your stomach. The test also checks for acid and nonacid reflux.


A small camera is inserted through your mouth so your doctor can view inside your esophagus, evaluate the health of its tissue, and identify problems that may affect the passage of food and liquid into the stomach.

Barium Swallow

A barium liquid is swallowed and travels the length of your esophagus. X-ray images show problems such as narrowed areas and other concerns, such as how food and liquid travel through your esophagus.

Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.

Why Choose Duke

Experts with Advanced Training
Depending on your needs, your medical team may include otolaryngologists -- ear, nose, and throat (ENT) doctors -- neurologists, gastroenterologists, head-and-neck surgeons, and speech pathologists who have advanced training in evaluating and treating swallowing disorders.

High-Level Evaluation and Treatment
Two of our speech pathologists are board certified in swallowing and swallowing disorders. They have completed additional training and maintain high-level skills in the evaluation and treatment of swallowing disorders. As a result, you receive the best level of care from the most knowledgeable therapists.

Personalized Swallow Therapy
Our speech pathologists use the latest technology and knowledge to evaluate your specific swallowing problem. They teach you safer eating and drinking strategies, offer guidance on positional or other behavioral changes during meals, and suggest specific food choices to people who experience difficulties with chewing, coughing, or choking while eating and drinking.

Research Advances
Our specialists have made major contributions that have improved treatment and outcomes for people with swallowing disorders. We pioneered the first minimally invasive surgery for Zenker’s diverticulum (a pouch at the back of the throat that traps food and impairs swallowing). We have performed this surgery, known as endoscopic staple diverticulostomy (ESD), on more patients than any other U.S. center and have achieved successful results in more than 95 percent of cases.