Swallowing Difficulty | Dysphagia and cervical instability

Swallowing Difficulty

Ross Hauser, MD

In this article we will discuss the problems of swallowing difficulties as they relate to  diagnosis of cervical instability caused by weakened, torn, damaged ligaments in the neck.

If you have questions about swallowing difficulty and other related problems, you can get help and information from our Caring Medical Staff.

Swallowing is a very complex process that involves the mouth, throat and esophagus. Many nerves and muscles affect the correct functioning of these parts, and while part of the process of swallowing is under voluntary control, much of it is involuntary. Swallowing difficulty, also called dysphagia, involves the sensation that food is stuck in the throat or upper chest. This sensation may be perceived either high in the neck or lower down, behind the sternum, or breastbone. Swallowing difficulty can become a serious problem among the elderly, and between 20 to 40 percent of stroke patients suffer from swallowing difficulty.
Swallowing Difficulty

The role of cervical instability in swallowing difficulties

Problems with swallowing can originate from emotional or anxiety disorder, tumor, stroke, spasms, a structural problem, a diverticulum or outpouching in the throat, an obstruction or a disease such a Parkinson’s, Huntington’s or multiple sclerosis, among others. However, swallowing difficulty is most commonly due to an autonomic nervous system dysfunction that may be caused Barré-Lieou Syndrome, a condition in which the autonomic nervous system of the head and neck area is not working correctly, typically as the result of a ligament injury to the neck. In the context of this article we will limit our discussion to the difficult to understand myriad of problems related to cervical instability.

As written in our article – Cervical Neck Pain | Cervical Neck Instability, in our practice, we continue to see a large number of patients with a myriad of symptoms related to cervical instability including neck pain that does not respond to conservative treatments. The symptoms the patients describe are usually extremely debilitating and the patient often tells us that they are at the “end of their rope.” A feeling of abandonment by the medical community is also common complaint.

Researchers are starting to document the problems that could be arising from cervical instability. Swallowing difficulty being one of them. In the April 2017 issue of the Journal of bodywork and movement therapies, a combined team of researchers from the University of Padova and the University of Bologna in Italy documented a case history of a young female patient with swallowing difficulties.1

The patient complained of pain on the neck and swallowing dysfunction that was reduced by means of isometric contraction of cervical muscles. Isometric contraction is a routine exercise where the muscle and joint are held in a static position. In other words, the patient was able to find a position where if she held her head still she was able to swallow.

In this case study, the doctors perfromed am MRI that revealed an anterior C5-C6 disc protrusion associated with a lesion of the anterior longitudinal ligament. Barium radiograph showed a small anterior cervical osteophyte at C6 level.

Conclusion: Diagnostic hypothesis was a combination of cervical disc dysfunction associated with C6 osteophyte and reduced functional stability.

Surgery for swallowing difficulties – high risk – low reward?

Using exercise to help swalling difficulties in cervical isntability patients is clearly superior to surgery. The problems of surgical correction of swalling difficulties from boney overgrowth is documented in this research from Turkish surgeons from the Gulhane Military Medical Academy and Gelibolu Military Hospital.

This study was presented in The Journal of craniofacial surgery and discusses the advantages and disadvantages of anterior cervical osteophytes surgical procedures. (A frontal incision into the throat area or the mouth to get at the cervical bone spurs).

The doctors looked at the operative records of anterior cervical osteophytes patients who did not benefit from conventional treatments and underwent osteophytectomy (bone spur removal).

Five patients were operated with the transcervical anterolateral method (incision into the neck), and 3 patients were operated with the transoral procedure (through the mouth). Those using the transcervical method were likely to encounter complications. Although the transoral procedure is much safer, the patients may face postoperative pain, long healing time, and morbidities as hematoma, cervical instability, and infection after surgery.

While both surgeries can improve swallowing difficulties, the price of complications and further instaqbility in the future was warned about. The researchers did suggest that Transoral approach is not recommended due to slow healing times and postoperative pain, although it creates easier access to the spine.2

Treating Cervical Spine Instability is treating swallowing difficulties

We will see many patients who were told about surgeries, such as those spoke above and offered surgical consultation for his/her problem with swallowing if there is a concern the problem is due to a diverticulum or outpouching of the throat. However, the surgical recommendation is often compromised by the difficulty in diagnosis.

Conservative treatments may be offered to see if the surgery is warranted or, better yet, avoided.

Recommendations to relieve the symptoms may include a bland diet, eliminating caffeine or alcohol from the diet, modifying the consistency of foods to make them easier to swallow, elevating the head while sleeping, or therapy to strengthen the swallowing muscles, particularly when the swallowing difficulty seems to be the result of  neurological disorder. In certain situations drugs that slow the production of stomach acid, muscle relaxants or antacids may be prescribed.

However, the truth is, a person suffering from this often painful and dehabilitiating condition may be seen by numerous specialists and yet find no resolution for the symptoms and, thus, no understanding as to why the condition exists at all.

In our office we perform physical examination and use our Digital Motion X-ray machine, described in the video above to get at the cause of the problem rather than to simply seek to treat the symptoms. This helps us determine, if, as often, we are looking at a dysfunction of the autonomic nervous system.

Swallowing difficulties and/or Barré-Lieou Syndrome, which can cause swallowing difficulty as well as a host of other symptoms including neck, eye and facial pain, cervical vertigo, dizziness and ringing in the ears, is very treatable using Prolotherapy to the neck ligaments. Prolotherapy is, in our opinion, the safest and most effective non-surgical treatment for repairing ligament damage. It stimulates the body to repair the damaged and weakened areas by inducing a mild inflammatory reaction. Since the body heals by inflammation, Prolotherapy stimulates healing.

As mentioned earlier, swallowing difficulty may also be due to an autonomic nervous system dysfunction. While the actual cause of this dysfunction may be elusive, Neural Therapy to the head and neck area has been known to help with swallowing difficulties. Neural therapy involves the injections of anesthetics to help the nerves reset themselves. For example, if the patient had previously had surgery in the mouth or neck area, the scars would be injected as they can act as “interference fields” to the autonomic nervous system.

If you have questions about swallowing difficulty and other related problems, you can get help and information from our Caring Medical Staff.

1 Margelli M, Vanti C, Villafañe JH, Andreotti R. Neck pain and dysphagia associated to disc protrusion and reduced functional stability: A case report. Journal of Bodywork and Movement Therapies. 2017 Apr 1;21(2):322-7.

2 Erdur Ö, Tasli H, Polat B, Sofiyev F, Tosun F, Çolpan B, Birkent H, Öztürk K. Surgical Management of Dysphagia Due to Anterior Cervical Osteophytes. Journal of Craniofacial Surgery. 2017 Jan 1;28(1):e80-4.

Make an Appointment |

Subscribe to E-Newsletter |

Print Friendly, PDF & Email
Find out if you are a good candidate
First Name:
Last Name:
Phone:
Email:
Question:

Enter code:
captcha
Facebook Reviews Facebook Oak Park Office Review Facebook Fort Myers Office Review
SEARCH
for your symptoms
Prolotherapy, an alternative to surgery
Were you recommended SURGERY?
Get a 2nd opinion now!
WHY TO AVOID:
★ ★ ★ ★ ★We pride ourselves on 5-Star Patient Service!Come see why patients travel from all
over the world to visit our clinics.
Current Patients
Become a New Patient

Chicagoland Office
715 Lake St., Suite 600
Oak Park, IL 60301
(708) 393-8266 Phone
(855) 779-1950 Fax
Southwest Florida Office
9738 Commerce Center Ct.
Fort Myers, FL 33908
(239) 308-4701 Phone
(855) 779-1950 Fax Fort Myers, FL Office
We are an out-of-network provider.
© 2018 | All Rights Reserved | Disclaimer
National Prolotherapy Centers specializing in Comprehensive Prolotherapy,
Stem Cell Therapy, and Platelet Rich Plasma.

Meet our Prolotherapy Doctors and check out our Prolotherapy research.