Chronic inflammation of the throat usually manifests itself as pain or difficulty in swallowing. Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. The term odynophagia refers to pain or discomfort with swallowing. These may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see an otolaryngologist.
A very common cause of hoarseness or dysphagia in older adults is gastroesophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Many patients with reflux related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day, although this is variable. These people may have a sensation of a lump in their throat (globus pharyngeus), mucous sticking in their throat or an excessive desire to clear their throat.
Gastroesophageal reflux can often be treated by changing eating and living habits.
· eat a bland diet with smaller, more frequent meals
· eliminate alcohol and caffeine
· reduce weight and stress
· avoid food within three hours of bedtime
· elevate the head of the bed at night
If these don’t help, antacids between meals and at bedtime may provide relief.
If we suspect acid reflux as a cause of your problems we may institute a trial of a very potent medication for several months. If the medication improves the condition it is not only therapeutic but also diagnostic. Literature shows that continued treatment for up to 6 months may be necessary. Occasionally we will actually look at the entire esophagus with a flexible scope, or place a special sensor to measure acid for an entire day.
There certainly can be some other worrisome causes of dysphagia which warrant careful evaluation by the otolaryngologist.
Transnasal Esophagoscopy (TNE)
Contrast Agents for Swallow Studies