Swallowing Disorders

Swallowing is a complex action involving the mouth, throat, voice box and oesophagus, all controlled by the brain and nerves. When this process does not work smoothly, it is called dysphagia (swallowing disorder). It can affect both adults and children and should not be ignored.

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Common Symptoms

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• Coughing or choking when eating or drinking

• A feeling of food “sticking” in the throat or chest

• Wet, gurgly or hoarse voice after swallowing

• Pain when swallowing

• Recurrent chest infections

• Unexplained weight loss in adults

• Poor weight gain or failure to thrive in children

 

Any persistent swallowing difficulty, especially with weight loss, voice change or breathing symptoms, should be assessed.

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Key Causes

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Laryngopharyngeal reflux (LPR)

Stomach contents travel up beyond the oesophagus to the throat and voice box, causing throat clearing, chronic cough, a “lump in the throat” sensation and voice changes. LPR can make swallowing uncomfortable and is treated with lifestyle measures and reflux medication.

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Children: congenital anomalies and laryngomalacia

In babies and children, congenital abnormalities such as laryngomalacia (a soft, floppy voice box), cleft palate or oesophageal narrowing can disturb swallowing. Signs include noisy breathing, long tiring feeds and poor weight gain, and often need early specialist review.

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Strictures and stenosis

Narrowing of the throat, larynx or oesophagus may follow surgery, radiotherapy, long‑standing reflux or injury.

 

Patients notice progressive difficulty with solids, food sticking and weight loss.

 

Treatment may include endoscopic stretching (dilation) and medical therapy.

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Neurological and autoimmune conditions

Parkinson’s disease, multiple sclerosis (MS), systemic lupus erythematosus (SLE) and other neurolaryngological disorders can weaken or disrupt the muscles and nerves involved in swallowing, increasing the risk of aspiration and pneumonia.

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How Swallowing Disorders Are Investigated

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Assessment usually includes:

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• Flexible endoscopy through the nose to examine the nose, throat and voice box in the clinic

• Rigid endoscopy under general anaesthesia for detailed inspection, biopsies or dilation

• FEES (Fibreoptic Endoscopic Evaluation of Swallowing) to watch how food and drink move through the throat and whether they enter the airway

• Contrast swallow studies (X‑ray swallow) to see the timing and pathway of swallowing and detect narrowings

• Dual probe reflux testing to measure acid and non‑acid reflux and link it to symptoms

 

Treatment and When to Seek Help

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Treatment is individualised and may involve diet and lifestyle changes, reflux medication, swallowing therapy with a speech and language therapist, endoscopic procedures and, in selected cases, surgery.

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You should seek specialist assessment if swallowing difficulty is persistent or worsening, there is frequent choking or chest infection, unexplained weight loss or poor growth in a child, or new swallowing problems occur in the context of a neurological or autoimmune condition.