Difficulty Swallowing

Swallowing is a complex process that involves the mouth, the throat and the oesophagus. Humans swallow more than 600 times per day. Many nerves and muscles control the process of swallowing. The process of swallowing has four related stages;

  1. The first stage is the oral preparation stage, where food or liquid is prepared for swallowing through being chewed and manipulated in other ways.
  2. The next stage is the oral stage, where the tongue propels the food or liquid into the back of the mouth, starting the swallowing response.
  3. The third stage is the pharyngeal stage; the food or liquid is quickly passed through the pharynx, then into the oesophagus.
  4. In the final stage, it passes through the oesophagus into the stomach.

Difficulty Swallowing

The first and second stage have some voluntary elements, however the third and fourth are involuntary. Disordered swallowing generally occurs in the oropharyngeal and oesophageal stages. It is key to identify in which stage the disordered swallowing stems. Disordered swallowing may stem from problems with neural control, a muscular condition, neuroplasia, and inflammation.

Dysphagia is the perception that there is an impediment to normal swallowing. It either refers to the difficulty someone may have with initiating a swallow (referred to as oropharyngeal dysphagia) or it refers to the sensation that liquids are somehow hindered in their passage from mouth to stomach (referred to as esophageal dysphagia).

Dysphagia may simply be a result of interruption in the swallowing process, however they are regularly a result of other factors. These factors tend to differ between age groups. Simple things like a common cold, or poorly fitting dentures in the elderly, can lead to disordered swallowing for a short period of time.

Gastroesophageal reflux is one of the most common causes of disordered swallowing. This occurs when stomach acid causes discomfort through moving up the oesophagus into the pharynx. Hypertension, diabetes, and tumours in the throat or oesophagus may also lead to disordered swallowing.

Management of dysphagia requires the coordinated expertise of a number of health-care professionals. Primary care physicians, dieticians, nurses, and primary caregivers are all part of the management plan. The main aim is to optimize the safety of oropharyngeal swallowing whilst maintaining necessary nutrition and hydration and to improve oral health. This is all in an attempt to avoid aspiration pneumonia.

Management plans are based around the needs of the specific patient, and the results of the clinical and instrumental assessments. Modifying food consistencies and altering bolus presentation are regularly used techniques in the management plan.

Odynophagia, or painful swallowing, is most commonly associated with a strong uncomfortable feeling of burning in the throat. It may be a symptom of a serious disorder.

Painful swallowing may be the result of infections, such as;

  • Cytomegalovirus
  • Gingivitis
  • Herpes simplex virus
  • HIV
  • Pharyngitis
  • Thrush

The cause of the painful swallowing may be oesophageal:

  • Achalasia
  • Oesophageal spasms
  • Gastroesophageal reflux
  • Inflammation of the oesophagus
  • Nutcracker oesophagus
  • Ulceration of the oesophagus, especially common with doxycycline.

Other causes include;

  • Mouth ulcers
  • Foreign bodies in throat
  • Tooth abscesses.
  • Cancers
  • Pill oesophagitis. Where pills are not taken correctly they can lead to odynophagia.

Treatments of odynophagia vary with the different causes of the condition. If the underlying condition is treated, the odynophagia will generally cease


If you are having any difficulties in swallowing, contact Professor Havas and he can help you.