Radiation-Induced Dysphagia

Dysphasia simply means difficulty swallowing. Sometimes dysphasia is caused by radiation therapy, which can be an important part of treatment for cancers of the head and neck. In some people, the radiation causes the muscles and lining of the mouth, throat, and esophagus to stiffen, making swallowing difficult.

There are two types of dysphagia: Oropharyngeal dysphagia causes difficulty moving food and liquids from the mouth to the throat and esophagus. Esophageal dysphagia causes the esophagus to become scarred and narrowed—this is called a stricture—and food has difficulty passing through.

Symptoms of Radiation-Induced Dysphagia

The symptoms of dysphagia caused by radiation therapy may include the following:

• Pain while swallowing
• Inability to swallow
• Sensation of food sticking in the throat or chest
• Drooling
• Regurgitation (bringing food back up)
• Frequent heartburn
• Food or stomach acid backing up into the throat
• Unexpected weight loss
• Coughing or gagging when swallowing
• Avoidance of certain foods that cause trouble swallowing

Dysphagia can take the joy out of eating and drinking and can lead to complications such as malnutrition, weight loss, and dehydration. In addition, patients who aspirate liquids or solids (breathe them into the airway) can develop pneumonia, bronchitis, or other upper respiratory infections.

Diagnosing Radiation-Induced Dysphagia

To diagnose oropharyngeal dysphagia, your doctor will likely perform two or more of the following tests:

• Videostroboscopy: In this test, doctors use a lighted camera called an endoscope to see the larynx. They may use either a flexible endoscope (inserted through the nose and over the back of the throat) or a rigid endoscope (inserted through the mouth).
• Esophageal manometry: This test measures how well the muscles in your esophagus work when you swallow. After your throat and nose are numbed, a thin, flexible tube with sensors is passed through the nose and esophagus, and into the stomach. You will be asked to sip water during the test.
• Modified barium swallow study (MBS): During this test you will swallow a variety of substances coated with barium, a whitish paste that lights up during an x-ray, which lets the examiner see how substances move through the mouth, pharynx, and esophagus.
• Flexible endoscopic evaluation of swallowing (FEES): In this test, your doctor will pass a small, flexible fiberoptic scope through the nose and hold it above the larynx to watch food and liquid as they are swallowed.

Treatments for Radiation-Induced Dysphagia

When choosing the best treatment, your doctor will consider the type and severity of your swallowing disorder. Two important treatment goals are to make sure you are getting enough nourishment and to reduce your risk of pneumonia.

Treatments for dysphagia may include:

• Dysphagia therapy: A speech and language pathologist provides exercises to strengthen the swallowing muscles and re-coordinate the timing of the swallow.
• Dietary modifications: Your doctor will recommend a personalized diet plan that may include thickened liquids and pureed foods.
• Esophageal dilation: In this approach, your doctor will perform a procedure to stretch or dilate a tight esophageal sphincter or an esophageal stricture to help food pass through.
• Feeding tube: In severe cases, a swallowing disorder can lead to an inability to eat or drink enough to maintain proper nutrition. In these cases, a feeding tube is placed.

Why Choose Columbia

Rehabilitation for dysphagia is highly individualized and may offer immediate benefits to patients. Once you have been evaluated by our team of specialists, a trained speech therapist will help you develop strategies to change the way you swallow so that you can swallow safely again. Over the course of our sessions, we will also use targeted practice to strengthen certain muscles with the goal of restoring more of your swallowing ability.