Swallowing disorders
Duke specialists in swallowing disorders use sophisticated diagnostic techniques and the latest medical advances to treat adults and children who have difficulty swallowing, a condition known as dysphagia. Swallowing disorders may result from a variety of medical conditions including gastroesophageal reflux disease (GERD), stroke, dementia, Parkinson’s disease, traumatic brain injury, amyotrophic lateral sclerosis (ALS) and other neurological disorders. Children or adults who experience cleft lip and palate, achalasia, Zenker’s diverticulum, voice disorders or throat cancer may also require care from specialists trained in the treatment of swallowing disorders.
Expert care for swallowing disorders
Swallowing disorders can make it difficult for you to drink liquids without choking, or cause food to feel like it is stuck in your throat. You may experience frequent coughing and gagging while eating. Swallowing problems can result in 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, or painful swallowing. Regardless of your symptoms, we have the expertise and resources to identify what is wrong and help you eat and drink safely and comfortably, without fear of choking.
Choose Duke to treat your swallowing disorder because we offer:
- 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.
- Advanced medical records technology. Our secure online portal, Duke MyChart, allows you to view test results, make appointments, request prescription refills, and message your doctor using any Web-enabled device. Our technology also allows anyone on your care team to securely access your health information, making sure you always get care that's right for you and based on the latest evidence.
- Pediatric feeding disorders program. Comprehensive evaluation and treatment is provided to infants and children who have swallowing disorders, including problems with feeding and growth due to medical or behavioral conditions, including prematurity, genetic syndromes (such as Down’s syndrome), brain injury, cerebral palsy, food allergies, and digestive disorders.
SWALLOWING DISORDERS
Treatments
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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.
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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.
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May include dietary changes, such as adding a thickening agent to make liquids easier to swallow, 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.
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A balloon-tipped tube is passed through your mouth into the esophagus and inflated to stretch narrowed areas that impede swallowing. Performed as an outpatient procedure under local anesthesia.
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Treat certain swallowing problems by relaxing the upper esophageal sphincter, a muscular valve between the esophagus and throat.
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Treats 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, with less discomfort, than traditional surgery. No skin incisions are needed because surgery is performed through the mouth.
SWALLOWING DISORDERS
Tests
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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.
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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.
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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).
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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, if 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.
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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 non acid reflux from the esophagus to the stomach.
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A small camera is inserted through the mouth so your doctor can view inside your esophagus to evaluate the health of its tissue, and identify problems that may affect the passage of food and liquid into the stomach.
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A barium liquid is swallowed, and travels the length of your esophagus. X-ray images are taken while the liquid passes through your esophagus to show problems such as narrowings, and other concerns, such as how food and liquid travel through your esophagus.