Head and neck cancers, autoimmune diseases, neurological disorders and aging are among the various conditions that can cause difficulties with swallowing. For people impacted, experts at the Johns Hopkins Dysphagia and Deglutition Clinic are available to help.

“Swallowing — although it’s something that we often take very much for granted and don’t give much thought — actually necessitates six cranial nerves and more than 26 muscle pairs across the oral cavity, pharynx, larynx and esophagus to function in a coordinated, precise fashion,” explains otolaryngologist James Clark, co-director of the clinic. “It takes a lot of coordination, and doesn’t take much for our swallowing to get disrupted.”

Patients who have been through surgeries for head and neck cancers may have had structures like parts of the tongue, palate, pharynx or larynx removed, which can interrupt typical swallowing, adds clinic co-director Rina Abrams, a speech language pathologist. Radiation and other cancer therapies can lead to fibrosis, or stiffening of the tissues involved in swallowing, even many years after treatments are complete. Some 60–90% of patients can be affected, she says.

As a result, patients may experience a range of difficulties, from having trouble getting food or drinks to go down their esophagus, or certain foods’ textures, such as those in meats or bread, feeling like they’re stuck. At times, patients are unable to produce enough saliva to moisten and lubricate food before swallowing. In other worrisome cases, Clark says, patients may have a loss of sensation, placing them at risk for silent aspiration.

Clark, Abrams and colleagues offer several tests using thin, flexible tubes to properly diagnose swallowing disorders. These include fiberoptic endoscopic evaluation of swallowing (FEES), to view the throat during swallowing; a flexible laryngoscopy, a procedure to look at the back of a person’s throat and voice box; a sialendoscopy, to diagnose salivary gland disorders; and a transnasal esophagoscopy, to view swallowing action in the esophagus and stomach.

Once the condition is identified, they can offer treatments from dilation or stretching of the esophagus to pharyngeal injections to swallowing therapy. Johns Hopkins is one of few centers that use an infinity symbol-shaped balloon during dilation rather than a cylindrical one to reach more of the upper esophageal sphincter.

Abrams heads up the swallowing therapy offerings, which can cover exercises to strengthen muscles involved in swallowing, behavior therapy that coaches patients on aspects like eating slower, as well as myofascial release treatments to relax certain muscles.

Many of the problems managed in the clinic cross specialties, Clark says. “Our goal is to be a one-stop shop, where we can treat issues from the mouth down to the stomach.” To that end, plans are underway to bring on board a gastroenterologist and dietitian. “We’re also hoping to develop a multidisciplinary dysphagia round that can include other healthcare systems within the region,” he says.

To make an appointment or refer a patient, call 443-997-6467