Why does my feeding tube hurt?
When food doesn't go down anymore
Based on the tongue and soft palate movement as well as the sensitivity to touch, they can reliably diagnose functional disorders of the responsible cranial nerves. Insufficient lip closure, for example in facial paralysis after a stroke, explains why the person affected cannot keep their food in their mouth adequately while eating (2).
In the event of pain or possible problems deeper in the neck, an endoscopic examination of the head and neck area is useful, which is carried out by the closely cooperating departments of ENT medicine, phoniatrics and pediatric audiology. With rod optics or flexible endoscopes, the throat, larynx and upper esophagus can be easily assessed. The doctor can assess the mucous membrane and pays special attention to the movement of the vocal folds and their closure. A lake of saliva in the throat indicates a serious disorder. If a disorder of the esophageal phase is suspected, the reflection of the esophagus and stomach provides information about heartburn, bleeding or tumors. These examinations are typically carried out by an internist, especially a gastroenterologist.
Various imaging methods such as ultrasound, computer and magnetic resonance tomography are used to visualize the soft tissue of the neck between the surface of the skin and the throat. Enlarged thyroid glands, lymph nodes or malignant tumors can be assessed in this way.
In order to be able to assess the act of swallowing, the endoscopic swallowing examination (FEES) and the so-called X-ray swallowing (VFSS) help. With FEES, a flexible endoscope a few millimeters thick is inserted through the nose. The swallowing of test meals is then observed in different consistencies and head positions. In addition, the efficiency of swallowing therapeutic exercises can be tested in order to make treatment by speech therapists more effective. With the X-ray swallow, the swallowing of a contrast medium is recorded in milliseconds under fluoroscopy. Narrow points and their nature (soft or fixed) are just as visible as irregularities in the throat wall. The FEES and the X-ray Pap swallow are functional examinations of the act of swallowing; their information complement each other.
Different clinical pictures
Various underlying diseases can trigger swallowing disorders. Therapy is based on this. A few case studies should illustrate this. Since drug side effects are particularly interesting as triggers for pharmacists, this example is presented here.
Drug side effects: In a 37-year-old patient with severe schizophrenia, the disease could only be stopped with the atypical neuroleptic clozapine so that the patient could be discharged from hospital. Unfortunately, there was excessive salivation (hypersalivation), which led to "drooling". This stigmatizing side effect of clozapine put compliance at risk. By injecting botulinum toxin into the parotid glands, the formation of saliva was effectively reduced for several months. The toxin interrupts the secretory nerve impulses to the salivary glands. This one-time, very long-term treatment without drug interactions can improve compliance, especially for special patient groups.
Zenker's diverticulum: A 72-year-old woman reports increasing problems swallowing meals. Usually several minutes, but also hours after meals, she chokes out the undigested food. As a result, she hardly dares to go to public events. The X-ray swallow showed a bulging of the upper esophagus (Zenker's diverticulum, box), which is based on a weak muscle wall. Food accumulates in the diverticulum instead of moving further into the stomach. Under general anesthesia, this muscle threshold is cut through endoscopically by laser surgery. In this way, the pouch is connected to the actual swallowing path again, and the swallowing problem is eliminated.
Reflux Laryngitis: A 64-year-old man who is significantly overweight complains of a severe dry mouth and a foreign body sensation in the throat that lasts all morning, especially after waking up. The voice is often occupied. At meals he had the feeling that he had to "swallow" against resistance; after eating it burns behind the breastbone. The laryngoscopy at the ENT specialist showed swelling of the posterior larynx entrance near the mouth of the esophagus. A gastroscopy revealed significant irritation of the mucous membranes in the esophagus; in addition, the Helicobacter pylori test was positive. After eradication treatment with two antibiotics and a proton pump inhibitor, the difficulty swallowing disappeared. Weight reduction is also helpful.
Tumor diseases: For the past five weeks, a 61-year-old man has found it increasingly difficult to swallow solid foods. He was assaulted by a sharp pain in the right jaw and neck area; he breaks off meals more and more often or even avoids them. He has already accidentally lost several kilograms of weight. Because of the burning, he reduced smoking to a box. Up until 15 years ago he drank several liters of beer a day, but is now abstinent. Now he noticed blood while brushing his teeth. During the examination with a tongue depressor and lamp, the doctor found a large ulcer on the right side of the tongue. The histological examination confirmed a carcinoma of the right cervical lymph nodes. Since neither the lungs nor the liver were involved, the cancer and the right cervical lymph node were completely removed. Irradiation for several weeks followed to reduce the risk of relapse.
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