Lawrence Chow / ENT Doctor
What Are Your Surgical Options for Dysphagia?
In some cases, surgery is a must in addressing dysphagia, a condition characterized by persistent difficulty in swallowing. Surgery is usually recommended when the underlying cause is GERD, pharyngoesophageal diverticulum, throat blockages, achalasia, or esophageal cancer.
The type of surgery will depend on the underlying cause. Furthermore, speech and swallowing therapy will likely be recommended after recovery from surgery. Here are three options that you may want to discuss with your ENT doctor.
Heller Myotomy
The Heller myotomy procedure is typically used in the treatment of achalasia, a disorder of the esophagus that makes swallowing abnormally difficult. This is a minimally invasive procedure wherein several tiny incisions are made in the esophagus, followed by the insertion of small scope into these tiny incisions.
The small scope has miniature surgical instruments passing through it while a video camera connected to it sends enlarged images of the esophagus to a monitor. The surgeon can then perform the operation by manipulating the miniature instruments in the scope.
The Heller myotomy procedure has several advantages that make it popular among surgeons and patients with dysphagia caused by achalasia. These include:
- Less pain after the operation since only minimal manipulation has been done
- Faster recovery
- Shorter stay in the hospital, usually 1-2 days, as compared with the possible 7-day stay for a conventional open procedure
In short, you can more quickly return to your normal activities and work.
Peroral Endoscopic Myotomy (POEM)
Yet another possible surgical option for the treatment of swallowing disorders like achalasia is peroral endoscopic myotomy (POEM). This is an endoscopic procedure wherein your surgeon inserts an endoscope through your mouth and down your throat. Your surgeon then makes an incision in your esophagus’ inner lining and cuts the muscle responsible for dysphagia.
POEM is an in-patient procedure requiring between two and three hours for completion. Like the Heller myotomy procedure, it’s popular because it doesn’t require incisions in the abdomen or chest. It also doesn’t require long hospital stays.
Esophageal Dilation
The medical professionals qualified to perform an esophageal dilation are otolaryngologists, or ear, nose and throat specialists, and gastroenterologists. Esophageal dilation stretches the abnormally narrow passages of the esophagus, known as strictures, which can be caused by underlying medical conditions.
In it, your ENT doctor inserts an endoscope into your esophagus, just as with the POEM procedure. He then inflates the balloon attached to the endoscope, which results in the gentle expansion of the strictures.
Esophageal dilation is performed as a treatment for certain swallowing disorders like:
- Achalasia, wherein the sphincter muscle in the esophagus becomes abnormally tight
- Esophageal stricture, or the narrowing of the esophagus
- Schatzki’s ring, an abnormal ring of tissue at the point where the esophagus and stomach meet
These three surgical options have their pros and cons in terms of the success rate, total cost and risks for side effects and complications. You should be well aware of these things before going under the knife, so to speak.
For details of our ENT services, diagnosis, and treatment, please consult our ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Be Prepared to Answer Questions and to Ask Questions During Your Dysphagia Appointment
We experience difficulty swallowing, known as dysphagia, at one point or another, usually when we attempt to swallow large food or when we eat too quickly. When dysphagia happens occasionally, there’s no cause for concern as it’s quite normal. But if you experience persistent dysphagia, you should see your ENT doctor as soon as possible.
Your persistent difficulty may be a sign of an underlying medical condition. This is particularly true if it’s associated with discomfort or pain, perhaps extreme difficulty in swallowing that makes it impossible.
But before getting to your doctor’s clinic for your appointment, you may want to prepare a list of questions and be ready to answer questions from your ENT doctor. The exchange of questions and answers will contribute to a better appointment.
List Down Your Questions
On the phone while setting your appointment, you should ask about pre-appointment restrictions necessary for diagnostic exams. You may have to restrict your diet, for example. You should also list down your symptoms – what they are, when they started and how they are manifested – as well as your medications, drugs and supplements.
You should also write certain key personal information that may have affected your ability to swallow. These can include surgery, medications and major life changes and stressful events.
And don’t forget to list down a few basic questions. You don’t want to forget a question in the clinic and remember it when you’re already at home.
- What are the possible causes of my swallowing difficulty?
- Why are these risk factors in my case?
- What are the medical tests that I have to undergo?
- What are the possible medical interventions for my condition?
- What are the ways I can manage dysphagia with my other health conditions?
- What do I have to do in terms of lifestyle habits?
- What other resources can I refer to about dysphagia?
Don’t hesitate asking these questions as you are well within your rights to do so. Just be courteous so you can get the answers you’re seeking for.
Anticipate Your Doctor’s Questions
The appointment is, of course, a two-way street. Your doctor will also ask questions intended to determine the possible causes of your dysphagia and their corresponding treatments.
The questions your doctor will likely ask and for which you should ideally have ready answers are:
- When did your symptoms start?
- Were your symptoms occasional or continuous, chronic or acute, tolerable or painful?
- What things appear to alleviate or worsen your symptoms? (You may have a more difficult time swallowing some food, for example, than others)
- What other symptoms aside from difficulty swallowing have you experienced? (You may regurgitate food, or vomit after eating or drinking, or bring up black bile-like material or blood)
- Have you been unintentionally losing weight?
The back-and-forth exchange will eventually narrow down the possible causes of your difficulty in swallowing. Be honest in your answers even when it seems embarrassing – your ENT doctor has probably heard and seen it all in his line of work.
If you have been experiencing symptoms such as voice changes, constant coughing, pain when swallowing, ear pain and sore throat that has not disappeared for more than two weeks, get yourself checked by a qualified ENT doctor. It could be nothing but it’s always better to be safe than sorry.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Possible Causes of Dysphagia
Doctors use the medical term dysphagia to refer to swallowing problems. This can mean having trouble swallowing certain drinks or food items, or being unable to swallow at all. It can be caused by any of the following underlying conditions:
Neurological Causes
If you suffer any damage to your nervous system (brain and spinal cord), this damage can interfere with the nerves involved in starting and controlling the swallowing movement. This type of damage can be caused by a stroke, brain tumors, or myasthenia gravis, which is a very uncommon condition that weakens muscles.
Some neurological conditions can do damage to the brain and nervous system over time. These conditions include dementia, multiple sclerosis, Parkinson’s disease, and motor neurone disease.
Obstruction
If there’s an obstruction in the throat or the esophagus becomes too narrow, swallowing can become much more difficult. This type of problem can be caused by some type of throat or mouth cancer like laryngeal cancer or esophageal cancer. When the cancer has been treated, often the obstruction disappears as well.
Infections, such as thrush or tuberculosis, can also cause inflammation of the esophagus that can lead to swallowing difficulties. This is also true of gastro-oesophageal reflux disease (GORD), when your esophagus becomes narrower due to stomach acid causing scar tissue to develop.
Other conditions that can cause an obstruction include eosinophilic oesophagitis and pharyngeal (throat) pouches. When you have eosinophilic oesophagitis, your body reacts to certain allergens by building up a type of white blood cell in the lining of the esophagus. This buildup damages the esophagus lining and causes the swallowing difficulties. With throat pouches, your esophagus develops a large sack that reduces your ability to swallow.
Even radiotherapy can also cause an obstruction in the esophagus. The treatment can lead to scar tissue that can narrow the passageway in the throat.
Congenital and Developmental Conditions
Children can have problems with dysphagia if they’re born with a cleft lip and palate. Cerebral palsy can also affect the movement and coordination of the body parts needed for swallowing. Learning difficulties may also make it difficult for some children to learn to swallow.
Muscular Conditions
Though it’s rare, it’s also possible that a medical condition can affect the muscles needed to push down the food into the esophagus and into the stomach. Achalasia is one such muscular condition that’s sometimes associated with dysphagia. This condition causes the muscles in the esophagus to lose their ability to relax and open to let food through.
Another potential problem is scleroderma. This is when the immune system attacks healthy tissue. This can cause a stiffening of the muscles in the throat and esophagus, leading to problems with swallowing.
As the ENT problem is quite different from case to case, it is suggested to consult an ENT doctor for the appropriate ENT services and treatments.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
The Difficulties of Dysphagia Explained
Since food and water are essential to human existence, the difficulty in swallowing is indeed a health issue that affected individuals should pay attention to. In particular, every affected person should consult with their ENT doctor / ENT specialist since he or she may be affected with dysphagia. Let’s take a look at its difficulties and understand what can be done about them. Continue reading
Difficulty Swallowing: What Can I Do?
Difficulty Swallowing: What Can I Do?
Difficulty swallowing is medically referred to as dysphagia. It often indicates a problem in your throat or your esophagus. This condition is most common in older adults and babies, as well as in individuals with a nervous system disorder. There are many reasons why people have difficulty swallowing. Some are harmless and others require medical attention. If you only experience it once or twice, then it probably doesn’t merit a visit to the ENT doctor. But if you experience it frequently, it may mean you have a serious problem and you should see an ENT doctor as soon as possible. Continue reading
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另所有文章內使用的人名均為化名。
另所有文章內使用的人名均為化名。