Swallowing – Difficulty in Swallowing
Swallowing is a complicated function involving coordination of muscles of the face, the tongue, the pharynx, and the esophagus. These muscles are under the control of five pairs of nerves and the corresponding integration centers of the brain. Difficulty in swallowing is commonly caused, of course, by disease, obstruction, or compression of the esophagus. But it may also be caused by faulty nerve control or by diseases in the mouth, pharynx, or larynx.
A. Foreign Body Within the Esophagus. Large, irregular-shaped objects if accidently swallowed may lodge in the back part of the pharynx. Smaller objects may pass through the larynx into the air passages to the lungs. Objects of such shape and size that they enter the upper part of the esophagus will usually pass through its entire length. If they become lodged, it is usually in the upper esophagus. A foreign body lodged in the esophagus naturally interferes with swallowing. If it has sharp edges, it may injure the lining of the esophagus, causing symptoms that persist even after the object is removed. The removal of a foreign body from the esophagus requires the services of a physician.
B. Corrosive Injury and Stricture of the Esophagus. The swallowing of strong acids or alkalis causes serious injury to the lining of the esophagus, so that the patient may have to be fed by the injection of nutrient solutions into his veins. As the injury heals, there is a shrinking of the tissues with scar formation. The swallowing of food or even of liquid may again become difficult or impossible. Surgical treatment is often required.
C. Cancer of the Esophagus. Cancer of the esophagus occurs most commonly in the lower third. Difficulty in swallowing is usually the first and continuing symptom of such a development. This symptom should be reported early to a physician.
D. Paralysis of the Muscles ofSwallowing.
1. Achalasia or "Cardiospasm." In this condition the waves of contraction that normally propel the food or drink through the esophagus stop short of the stomach, and the food or drink accumulates in the lower part of the esophagus, causing it to stretch. One symptom may be pain behind the breastbone occurring after eating. The condition is aggravated in many patients by emotional stress.
2. Bulbar Palsy. This type of nervous system injury may destroy the nerve cells which control the muscles of swallowing. It can result from poliomyelitis or from arteriosclerosis of the blood vessels within the brain.
E. Pressure Against the Esophagus. Structures within the chest may press on the esophagus, causing difficulty in swallowing. These include aneurysm of the aorta, tumor, or diaphragmatic hernia.
F. Esophagitis. Inflammation of the esophagus may make swallowing painful.
G. Lesions of Related Tissues. Disease conditions developing within the mouth, pharynx, or larynx may interfere with swallowing, either because they are painful or because they interfere in a mechanical way. These include cancer of the tongue, cleft palate, inflammation of the lining of the mouth or pharynx, and cancer of the larynx.
H. Emotional Conditions. Fear or acute anxiety may cause "a lump in the throat" which makes swallowing difficult. A related condition, called globus hystericus, occurs under conditions of emotional conflict and makes it difficult for a person to swallow.
