TREATMENT FOR PHARYNGEAL SWALLOWING DISORDERS.   Recent research done in August 2020 shows that to improve quality of life, the swallowing problem to focus on is in the pharyngeal phase. (pubmed.gov, 32846813).

 

IF YOU HAVE BILATERAL REDUCTION IN PHARYNGEAL CONTRACTION (coughing after swallow because of residue in valleculae or pyriform sinus; feeling of food sticking in the throat).

1. Do the Masako maneuver: Hold your tongue between the teeth with the tip out ¼ inch and swallow. You should feel a strong pulling on the back of the throat. This exercises the glossopharyngeus muscle, pulling the pharyngeal wall forward.

2. Alternate swallows of solids and liquids. The liquid will wash the thicker stuff down.

3. Limit diet to liquids or thinner materials. They require less pressure to clear the pharynx.

4. Follow each food or liquid swallow with several repetitive dry swallows (to clear the pharynx of residue).

5. Try supraglottic swallow: Breathe in, swallow, and cough immediately without another breath.

6. Try voluntary airway protection by holding your breath.

7. Try clearing your throat to clear material from the pharynx.


IF YOU HAVE UNILATERAL PHARYNGEAL PARALYSIS (sensation of food sticking in the throat because of residue in valleculae or pyriform sinus; aspiration after the swallow).

1. Turn your head toward the affected side to close the open areas, which will direct material down the more normal side.

2. If there is poor tongue function too, tilt the head toward the stronger side to keep material on the stronger side.

3. Try the supraglottic swallow to clear residual material from the pharynx: Breathe in, swallow, then cough immediately without breathing in first.

4. Try alternating food and liquid swallows to wash away thicker food from the pharynx.


IF YOU HAVE CRICOPHARYNGEAL DYSFUNCTION due to failure of muscles to relax, so larynx doesn’t move up and forward (coughing after the swallow, gargle voice, excessive secretions, feeling of material sticking at the bottom of the throat, regurgitation).

1. If the problem is spasm in the cricopharyngeal muscle strong enough to prevent the larynx from moving up and forward, then wait for it to spontaneously recover, then after 5-6 months, consider cricopharyngeal myotomy.

2. If the problem is poor laryngeal motion up and forward, try the Mendelsohn maneuver: while swallowing, keep your larynx up for a few seconds before letting it drop.

3. If the problem is inadequate pharyngeal pressure during swallow, then try exercises to improve tongue base action, like trying to yawn, gargle, or pull tongue back. Also try rotating your head to the weaker side.


IF YOU HAVE A CERVICAL OSTEOPHYTE (a boney overgrowth of one of the cervical vertebra, which causes sensation of food sticking or difficulty swallowing it down).

1. Surgically reduce it.

2. Eat thinner foods—thicker foods will be harder to swallow.

3. Try changing head posture, rotating to one side or the other.


IF YOU HAVE REDUCED LARYNGEAL ELEVATION (which causes coughing after the swallow, coughing up food).

1. Do the Mendelsohn maneuver: keep your larynx up for a few seconds while swallowing, then let it drop.

2. Clear your throat immediately after the swallow to expectorate any residue.

3. Try the super-supraglottic swallow: Bear down with pressure while swallowing, then cough immediately after without sucking in air first.

4. Try a falsetto exercise to increase laryngeal elevation.


IF YOU HAVE REDUCED LARYNGEAL CLOSURE AT THE AIRWAY ENTRANCE (which causes coughing and aspiration during the swallow).

1. Do the super-supraglottic swallow: breathe in, bear down, swallow hard, and cough immediately afterwards without a breath first.

2. Take a breath, hold the breath, and bear down as an exercise.


IF YOU HAVE REDUCED LARYNGEAL CLOSURE AT THE VOCAL FOLDS (which causes coughing and aspiration during the swallow).

1. Do the supraglottic swallow: take a breath in, hold it, swallow, and cough immediately afterwards without breathing in again first.

2. Try foods and liquids of a thicker consistency that won’t splash easily into the airway.

3. If reduced laryngeal closure is combined with reduced pharyngeal contraction, thinner foods and liquids will be easier because they will clear out easier.

4. Try a forward, chin-down head posture while swallowing to narrow the airway entrance.

5. Try turning your head to the bad side.

6. Try placing pressure on the thyroid cartilage on the bad side.