[Editor’s note: The NFOSD would like to thank Ms. Nancy Swigert for volunteering her time to develop this article on swallowing disorder basics for teens and adults.]
If swallowing problems are present in teenagers, it is typically a continuation of feeding/swallowing problems the teen presented with as a younger child. Teens with developmental disabilities or chronic conditions, like cerebral palsy, may continue to present with swallowing problems throughout their life.
New onset of dysphagia in teens (or younger children) might occur as a result of a choking episode. Sometimes an isolated incident of choking on food will cause a fear of swallowing. The child may begin to avoid foods they have previously eaten without difficulty. They may limit the food and liquids they will eat to the extent that they are not receiving adequate nutrition and hydration. The child or teen will likely not be able to make the connection between the choking episode and the current restrictions he is imposing on himself. The teen’s physician will likely refer the child for a full swallowing evaluation to make sure there is no physical reason for the refusal to eat certain foods. The speech-language pathologist and physicians performing the assessment can then recommend intervention for the teen. This may include a referral to a psychologist to help the teen deal with the developed fear of eating.
Second only to children ages 0-4, teens and young adults (ages 15-24) experience the most traumatic brain injuries (http://www.cdc.gov/traumaticbraininjury/data/rates_ed_byage.html). One of the results of a traumatic brain injury (TBI) can be dysphagia. Depending on the location and extent of the injury, the dysphagia can be severe. Dysphagia has been estimated to occur in 13% of individuals suffering a traumatic brain injury, and in individuals with gunshot wounds causing the TBI, dysphagia can occur in 37% of individuals (http://neuroc99.sld.cu/text/dysphagiaTBI.htm).
Adolescents can experience dysphagia related to esophageal problems. The teen may experience gastroesophageal reflux, which occurs when stomach acid backs up into the esophagus. This can cause a sensation of a lump in the chest or throat, or the more commonly known symptom of “heartburn” or sour, burning sensation in the back of the throat. Other problems that can occur in the esophagus are esophagitis and esophageal spasm. Esophagitis is inflammation in the esophagus and can be caused by persistent reflux. Esophageal spasm can feel like chest pain. It may be caused by reflux or may be related to stress (http://patients.gi.org/topics/non-cardiac-chest-pain/).
Dysphagia in adults is usually related to one of two major categories: damage to the nervous system; and head and neck cancer
Dysphagia related to damage to the nervous system:
The dysphagia may be related to chronic or progressive diseases such as Parkinson’s disease, Alzheimer’s Dementia, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis, or Myasthenia Gravis. Dysphagia usually occurs after the adult has already been diagnosed with a neurological disorder. However, difficulty swallowing can sometimes be the first sign of a neurological disorder (http://www.ncbi.nlm.nih.gov/pubmed/20410858). Adults may fail to report swallowing problems to their physicians, but because it may be a sign of a more serious problem, the difficulty should be reported.
Dysphagia can also occur as a result of an injury to the nervous system such as a head injury, spinal cord injury, or stroke. Dysphagia may occur in 1/3 to 2/3 of individuals who have a stroke, depending on the type and severity of the stroke. There is an increased risk of pneumonia in patients with stroke who have dysphagia. (http://stroke.ahajournals.org/content/36/12/2756.full).
Spinal cord injuries can also cause swallowing problems. Individuals who suffer a spinal cord injury are more likely to have dysphagia if they also had a related head injury, had to have a tracheostomy tube inserted in their throat for breathing and/or had to have surgery on the cervical spine the area at the level of the neck. (http://jrnlappliedresearch.com/articles/Vol4Iss1/Brady.pdf)
Damage to specific cranial or peripheral nerves can also result in swallowing problems. There are at least seven cranial nerves controlling over thirty muscles involved in eating and safely swallowing. For example, the hypoglossal nerve sends impulses to almost every muscle in the tongue. The front, middle and back parts of the tongue and the sides of the tongue perform complex movements for drinking, chewing and swallowing. The trigeminal nerve controls the movements of the jaw for biting and chewing. Nerves like the facial and vagus are responsible for sensation and movement in the throat to protect the airway. (http://www.merckmanuals.com/home/brain_spinal_cord_and_nerve_disorders.html). Many different things can damage cranial or peripheral nerves, and when that happens swallowing problems can result. (http://www.emedicinehealth.com/neuropathy/page2_em.htm)
Dysphagia related to head and neck cancer
People who have been treated for cancer of the head and neck often experience swallowing problems. The cancer may have been in the mouth, particularly if the tongue was affected, or the throat. Laryngeal cancer can have a big impact on swallowing because the larynx serves as the main airway protector during swallowing. Dysphagia may be caused by the presence of the tumor in the mouth or throat. It can also occur after surgery has removed the tumor and parts of the mouth or throat.
Dysphagia can also be a result of the radiation therapy used to cure the cancer. Over time, radiation therapy causes the tissues in the area to become less flexible. This means that the structures that need to move in a coordinated fashion to allow the individual to chew and swallow may move more slowly, or may not move at all. This type of dysphagia, called late-effects dysphagia, comes on slowly so that sometimes the problem is not noticed until the point that it may be very difficult to change. Individuals who are undergoing chemo-radiation therapy benefit from learning swallowing exercises to practice on a daily basis to try and prevent this late-stage dysphagia from developing.