Formula Medical Group
Apple Valley, CA

James Krider, MD

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Swallowing difficulty

Swallowing is an almost automatic act that requires careful coordination of muscles and structures in the mouth and throat to make sure that food, water, and air end up in the right places.

Just beyond the soft palate in the area called the oropharynx, the passage divides, with one tube (the windpipe or trachea) for air and the other (the esophagus) for food and water. The larynx (the speech organ) is situated at the top of the trachea, and it is protected by the epiglottis, a piece of cartilage that acts as a trapdoor to keep food and water out of the trachea. Thus, when a person swallows, the epiglottis instantaneously blocks off the larynx and trachea, preventing food from entering them.

Problems or pain upon swallowing are usually nothing more than a symptom of a simple sore throat. A more serious cause may be an object lodged in the throat, particularly in small children. Persistent difficulty in swallowing may be a sign of a disorder that requires medical attention.

Causes of swallowing difficulty

Everyone feels anxious now and then, but in some people anxiety becomes so pervasive that it interferes with normal function. Symptoms may include a dry mouth, difficulty in swallowing, a rapid heartbeat, feelings of fear or dread, among others. In extreme cases, anxiety evolves into panic attacks, characterized by Overbreathing and paralyzing fears.

This highly contagious infection affects the throat, skin, heart, and central nervous system, and can be serious or even fatal if treatment is delayed. It is easily preventable through immunization with diphtheria vaccine, which should be given beginning in early infancy. In the early stages, symptoms include sore throat, difficulty in swallowing, a low fever, and swollen neck glands; later, the airways become obstructed, causing breathing difficulties, and more severe symptoms, including possible suffocation and shock.

Dry mouth
Any reduction in saliva production can make it difficult to swallow food. Dry mouth can be due to an infection of the saliva glands or radiation treatments of the head or throat. The condition is also a side effect of many common

Difficulty swallowing can be emotional or physical in nature.


Difficulty swallowing can be emotional or physical in nature.


Esophageal narrowing
Inflammation can cause scarring and narrowing of the esophagus, thereby interfering with swallowing. Ability to swallow may decrease suddenly or gradually. Other symptoms include pain in the mouth or chest after eating, increased salivation, rapid breathing, and vomiting. People with the eating disorder called bulimia may develop esophageal inflammation and scarring as a result of frequent induced vomiting following eating binges. Sometimes a baby is born with a malformed esophagus that makes swallowing difficult or impossible. In such cases, prompt corrective surgery is needed to prevent death.

Esophagus cancer
This form of cancer usually begins in the esophagus, but may also spread there from other parts of the body. The primary symptoms are swallowing difficulty or pain, rapid weight loss, and regurgitation of bloody mucus. Early diagnosis and aggressive treatment are essential to survival.

Myasthenia gravis
This disorder is characterized by progressive deterioration of muscles, especially those of the face and head. Symptoms include increasing fatigue of the affected muscles, along with drooping eyelids, double vision, loss of normal facial expression, and difficulty in swallowing, breathing, and speaking clearly.

Throat infections
Throat inflammation and infection can be caused by a variety of germs, including bacteria, viruses, and fungi.

Depending upon the cause, the pain, difficulty swallowing, and other symptoms may come on gradually or rapidly. Some throat infections, such as a strep throat, can have serious consequences if treatment is delayed. Others, such as the pharyngitis that often accompanies a cold or flu, resolve themselves as the underlying viral illness clears up.

The tonsils are small clumps of lymphatic tissue at the back of the throat. They help prevent sinus, mouth, and throat infections from spreading to other parts of the body. Sometimes the tonsils themselves become infected and swollen, resulting in throat pain, swallowing difficulty, chills and fever, and swollen lymph nodes on either side of the jaw. Tonsillitis is most common among children. In some instances, tissue adjacent to the tonsils becomes infected, forming an abscess (a condition commonly referred to as quinsy). This can become life threatening if the swelling blocks the breathing passages, resulting in suffocation.

Advice about swallowing difficulty

  • Signs of a possible choking emergency, in which the person is unable to speak, call for immediate first aid (the Heimlich maneuver) to dislodge the object.
  • Swallowing difficulty that persists and worsens should be promptly investigated by a doctor.
  • People who suffer from dry mouth should try increasing fluid intake when eating to ease swallowing.
This article was last reviewed November 14, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
Cancer, esophagus
Esophageal webs
Esophagus, malformed
Esophagus, narrowing
Myasthenia gravis
Panic attacks
Salivary-gland disorder
Strep throat
Throat abscesses

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