[Dysphagia] Swallowing/sleep apnoea

[knottsknest at iprimus.com.au (David and Daphne Knott)]

I am a Speech Pathologist new to Australia and currently studying swallowing and dysphagia (a requirement by Speech Pathology Australia). When my father heard what I was studying he described a swallowing problem he has and he asked if I could help him identify the problem. Since my experience in adult dysphagia is still limited my tutor referred me to this website and I am hoping to enlist advice from experts in the field!



My father is 67 years old and he does have some significant medical issues that might all be inter-related.

This is what he first described:



"First of all the problem has been with me for years. I saw an ENT (Around 1980) about it. It had started to hurt. He looked and said that I had a nervous throat and it became worse under stress. At the time I was working under extreme stress at the Bank. Whenever I have been to a dentist he has said that I have a sensitive throat because I gag when they hang the drain over my teeth or put cotton wool between gum and lips. I can't hold a pencil or pipe between my teeth without gagging. It is difficult to explain what I feel when I swallow. I swallow food, vitamin pills, water etc. with ease. I don't feel a lump. It feels more like soft tissue either at the back of the throat or near the entrance to the throat from the nose, that seems to block the nose and throat simultaneously. It is most prevalent when I have a stuffy nose or at night when the mouth and throat are very dry. Then it is impossible to breathe through nose or mouth because as I try to swallow there is this constriction against my palate. If I drink water it eases. Sometimes I can be talking and it happens out of the blue. It feels as if I am trying to talk past a narrowed throat entrance with a badly congested nose although the nose is completely clear. If I had a better understanding of the throat components and their movement during the swallowing process I might be able to explain better or pinpoint the obstruction. There is no hoarseness after meals."

 

I sent my father a full explanation of the anatomy involved in swallowing and I asked him a few further questions. His responses follow:

 

Main problem areas:

"Severe mouth dryness at night. Wake up with tongue unable to move freely and frequently sticking to palate. At that time even after a drink of water throat and nose seem to close (Feels like a narrowing or loose tissue causing a blockage as I swallow) and sometimes panic sets in as I try to get my breath back. Situation is aggravated when my nasal passages are not absolutely clear. No problem whatsoever with swallowing any foods."

 

"Teeth on lower jaw limited to front (5) only. To counteract this I eat slowly and chew for longer.  There are no digestive problems as a result. There does seem to be occasional blockage quite high in chest where I have a hernia."

 

Do you ever feel constriction in this area (soft palate) preventing the co-ordination of breathing and           

     swallowing? 

"Yes. This is where my problem lies. This is the feeling of panic that I described earlier. Sometimes when I am talking normally it happens and I keep having to swallow as though my nose were blocked although there is no nasal blockage at the time."

  

 Do you ever experience "heartburn"/discomfort of acid reflux after a meal?

" Occasionally in the past. I put it down to the hernia at the time. No problems during the past two years though."

 

 Do you ever feel the sensation of food sticking in your chest?

 "Occasionally in respect of the hernia as explained before. Only this is left without any heartburn sensation."

 

Do you experience coughing or choking during meals or while drinking liquids? 

"Very occasionally if there is a sharp intake of breath preceding a sneeze etc. In those circumstances sometimes a small particle seems to want to enter the lung. Invariably after long coughing spells I become very chesty. Then mucous forms around the particle and it is coughed up."

 

Besides long term sleep apnoea and snoring and recent recovery from Bell's Palsy, the following medical conditions also exist.

Mild asthma. Wheezing and shortness of breath. Never had full blown asthma. Takes asthma capsules as needed over past 5 years.

Suffers from water retention as a result of enlarged prostrate (benign). Recent chronic water retention in feet and torso. Currently taking water retention tablets every morning for the past month.



It is not easy to persuade my father to seek medical advice. I'm hoping that if I can pinpoint the problem, I can direct him to the correct testing procedures to avoid unnecessary medical visits. If anyone has ideas on this case I will be most grateful to hear from you. I suspect the sleep apnoea is a significant contributing factor. My father is overseas so our correspondence is by phone and email but I do have sisters on standby to help him address these medical issues.



Daphne Knott

Speech Pathologist