Food Sticking In Throat Research Articles

'Food Sticking in My Throat': Videofluoroscopic Evaluation of a Common Symptom.

Prevalence of the symptom of food 'sticking' during swallowing has been reported to range from 5 to 50%, depending on the assessment setting. However, limited objective evidence has emerged to clarify factors that contribute to this symptom. Three hundred and fifteen patient records from an outpatient dysphagia clinic were reviewed to identify patients with symptoms of 'food sticking in the throat.' Corresponding videofluoroscopic swallowing studies for patients with this complaint were reviewed for the following variables: accuracy of symptom localization, identification and characteristics (anatomic, physiologic) of an explanatory cause for the symptom, and the specific swallowed material that identified the explanatory cause. One hundred and forty one patients (45%) were identified with a complaint of food 'sticking' in their throat during swallowing. Prevalence of explanatory findings on fluoroscopy was 76% (107/141). Eighty five percent (91/107) of explanatory causes were physiologic in nature, while 15% (16/107) were anatomic. The majority of explanatory causes were identified in the esophagus (71%). Symptom localization was more accurate when the explanatory cause was anatomic versus physiologic (75 vs. 18%). A non-masticated marshmallow presented with the highest diagnostic yield in identification of explanatory causes (71%). Patients complaining of 'food sticking in the throat' are likely to present with esophageal irregularities. Thus, imaging studies of swallowing function should include the esophagus. A range of materials, including a non-masticated marshmallow, is helpful in determining the location and characteristics of swallowing deficits contributing to this symptom.

‘Breath Stacking’ Reported to Make Swallowing Safer in ALS

ORLANDO, FL—A simple breathing technique that takes only minutes to learn can help most patients with amyotrophic lateral sclerosis (ALS) not only coug h more effectively but also swallow more safely. The technique, called “breath stacking,” has been known to improve cough for almost two decades. A new study has shown that it also increases the patient’s ability to protect the airway during swallowing, lowering the risk of aspiration and choking. “This is a very important approach to therapy that can make a big difference to our patients in terms of both quality of life and length of life,” said Robert G. Miller, MD, director of the Forbes Norris MDFA/ALS Research Clinic at California Pacifi c Medical Center in San Francisco, who was not involved in the study. “Unfortunately, relatively few neurologists are familiar with it.” Study investigator Stuart Cleary, PhD, assistant professor of speech pathology and audiology at the University of Alberta in Edmonton, described the fi ndings here at the ALS-MND Society meeting here in December. Breath stacking is meant to interrupt a cycle of poor airway maintenance that is typical in ALS. As breathing muscles weaken, the ability to cough is impaired, leading to accumulation of mucus plugs in the smaller airways. At the same time, poor airway protection during swallowing increases the risk of aspiration. The breath stacking maneuver is simple, Dr. Cleary explained. The patient uses a resuscitator bag equipped with a one-way valve and mouthpiece to take a series of breaths without exhaling, expanding the lungs beyond what he or she can accomplish with a single breath. The resulting stretching of the lungs and chest wall opens clogged airways and increases chest compliance, leading to reduced airway resistance to airfl ow. “This translates to improved lung volumes, higher peak cough fl ows and improved airway clearance,” he said. “As a swallowing therapist, I am interested in protecting the airway during mealtime,” Dr. Cleary said. Anecdotal reports from ALS centers in Canada, where the practice is somewhat more common, indicated the technique seemed to improve swallowing safety, so he set out to test that in a rigorous fashion. Dr. Cleary enrolled 29 ALS patients with a mean age of 65 years, a median ALS Functional Rating Scale score of 28 out of 48, a mean forced vital capacity (FVC) of 58 percent of predicted, and a mean peak cough fl ow (PCF) of 245 L/min. Participants performed fi ve trials of breath stacking, each separated by about 20 seconds. Respiratory and swallowing tests were performed before treatment, and at 15 and 30 minutes afterward. Patients served as their own controls, performing the same tests on different days without breath stacking. Consistent with previous studies, peak cough fl ow improved following breath stacking, rising approximately 50 L/min following treatment, an increase which lasted 30 minutes after treatment. The difference was signifi cant for both time points versus baseline and versus the control value. Dr. Cleary also found that breath stacking improved patients’ ability to perform other airway-clearing techniques, such as throat clearing and “hawking,” as well as the supraglottic swallowing maneuver, which consists of holding one’s breath while swallowing, closing the vocal cords and protecting the airway. The combined effect, Dr. Cleary said, is that for up to 30 minutes after breath stacking, ALS patients were better able to cough, to clear mucus or food stuck in throat, and to swallow safely.

Facioscapulohumeral Muscular Dystrophy: A Radiologic and Manometric Study of the Pharynx and Esophagus

Facioscapulohumeral muscular dystrophy (FSHD) is not a recognized neuromuscular cause of dysphagia. However, a study of pharyngoesophageal function in FSHD has not been performed or reported. The aim of this study was to ascertain by relatively noninvasive techniques whether the dystrophic muscle disease that underlies FSHD involves the pharyngeal and/or the esophageal striated and smooth muscles. We used conventional cineradiography and intraluminal esophageal manometry on separate occasions to study pharyngeal and esophageal function in 20 patients with FSHD at various stages of disease, with or without complaints of deglutition. Age- and sex-matched control data were used for comparison of the manometric component of the study. Twelve men and eight women with FSHD were studied. The mean patient age was 38.1 years (41.9 years for controls), and the age range was 19-61 years (22-55 years for controls). The mean disease duration was 16.7 years (range = 4-39 years).Five patients admitted to having intermittent oropharyngeal dysphagia (difficulty to initiate swallowing, cough after swallowing, sensation of food stuck in throat, or nasal regurgitation), and three patients admitted to intermittent esophageal dysphagia (difficulty swallowing both liquids and solids). Chest roentgengrams showed a hiatal hernia in four patients, but no active cardiopulmonary disease. Abnormal instrumental results were documented in eight patients: Cineradiography detected ineffectual pharyngeal contractions (2 patients), pharyngeal diverticula but normal pharyngeal motility (2 patients), and decreased cricopharyngeal and upper esophageal relaxation (2 patients). The mean manometric pressure of the patient group was not significantly different from the control data. However, manometry detected motility abnormalities that were not reflected in the mean data and included increased lower esophageal sphincter resting pressure with normal or abnormal relaxation (2 patients) and inconsistent, high-amplitude, long-duration, primary peristaltic contractions (1 patient). Patients with FSHD did not spontaneously volunteer intermittent complaints of deglutition. This study did not definitely establish that the cause of abnormal pharyngeal and cervical esophageal function was related to the dystrophic process that underlies FSHD. Any esophageal dysmotility was nonspecific and insignificant and was caused by an undetermined, probably neuropathic, process unrelated to the muscular dystrophy.

Quality of Life Related to Swallowing After Tongue Cancer Treatment

The surgical treatment of tongue cancer, with or without reconstruction and/or radiotherapy, leads to different levels of voice, speech, and deglutition disorders. Evaluating the quality of life related to these swallowing alterations is important to further our knowledge about the impact of such alterations from the patient's point of view. Our objective was to describe the quality of life related to swallowing in patients treated for tongue cancer, using specific questionnaires. Twenty-nine patients participated in the study for a minimum of one year after oncologic treatment. Patients with advanced disease who underwent radiotherapy had significantly worse scores in most domains. The aspects related to how to deal with deglutition problems, time taken for meal consumption, pleasure in eating, chewing problems, food sticking in throat and mouth, choking, and the knowledge of feeding restrictions, which were evaluated by different domains of SWAL-QOL, were factors that contributed to a negative impact for patients with advanced-stage tumors who underwent radiotherapy.