Are you or your loved one having trouble swallowing? Let's talk about it.

Swallowing is something most of us do without thinking - until it becomes difficult.

Studies show that up to 15 percent of the elderly population is affected by dysphagia (the medical term for difficulty swallowing).

Trouble swallowing can range from mild inconvenience to a sign of a more serious condition.

It may feel like food is getting stuck, cause coughing or choking during meals, or eating takes much longer than usual. Some people find they are not able to finish their meals at all. Others avoid certain foods or liquids altogether because they are afraid of choking.

Over time, this can result in dehydration, weight loss, and poor nutrition, which weakens the body further and makes recovery more difficult.

Having dysphagia (difficulty swallowing) also increases risk of getting aspiration pneumonia, a lung infection caused when food, liquid, or even saliva accidentally enters the lungs instead of the stomach. This can lead to repeated chest infections, persistent coughing, or in severe cases, life-threatening pneumonia.

Causes of dysphagia (difficulty swallowing)

There are many possible causes of swallowing difficulty, including:

• Age-related changes in swallowing function
  
  
• Muscle or nerve problems affecting the throat or oesophagus
  
  
• Complications from acid reflux or previous surgery
  
  
• Neurological conditions such as stroke or Parkinson's disease
  
  
• Structural issues such as narrowing or growths 

Managing dysphagia

Managing swallowing difficulty involves a multifaceted approach.

This usually includes assessment by an ENT doctor and a speech therapist. Treatment is tailored to the underlying cause, and, when needed, diet modifications, safe swallow strategies and swallow exercises to strengthen the muscle involved are advised.

If you notice persistent swallowing difficulties - especially if accompanied by pain, voice changes, coughing during meals, or unintentional weight loss - it is important to seek medical attention early.

Many causes are treatable, and timely intervention can improve your safety, nutrition, and quality of life.

Feel free to ask your questions in this forum, Dr Ng is here to help you understand your symptoms and guide you on the next steps.

Dr Christina Ng is a Consultant at the Department of Otorhinolaryngology – Head and Neck Surgery, Sengkang General Hospital (SKH).

Dr Ng trained in Singapore and completed advanced fellowship training in Laryngology and Bronchoesophagology at Stanford University, specialising in complex voice, airway and swallowing disorders. 

As an active clinician, researcher, and educator, Dr Ng holds academic appointments at Duke-NUS Medical School, Lee Kong Chian School of Medicine, and Yong Loo Lin School of Medicine.

She also serves as Clinical Core Faculty of the SingHealth Otolaryngology Residency Programme. She has published extensively in peer-reviewed journals, serves as a journal reviewer, and is a member of the American Broncho-Esophagological Association.

Related articles:
Dysphagia (Difficulty Swallowing): What To Do

Exercises for Dysphagia: How Tongue Stretching Can Help

Swallowing Exercises for Dysphagia: Masako Maneuver

Swallowing Exercises for Dysphagia: Effortful Swallow Exercise

1. Question by Cheong TW

Dear Dr Christina Ng,

For at least 5 years now, I noticed that I have some difficulty swallow food that is a bit dry and sticky such as biscuits and peanut butter.

Sometimes when I swallow tablets with water I could feel they don't go down the oesophagus easily.  Tucking in my chin when swallowing sometimes helps.

Occasionally when I sleep in the night my throat gets irritated and I had to cough to clear the irritation. It could be due to acid reflux.  If I swallow enough saliva, the irritation goes away.  However, I find it difficult to swallow my saliva when I am lying down.

Please advise what I should do. Thank you.

Answer by Dr Christina Ng

Hi Cheong TW, swallowing dry food such as biscuits and peanut butter and larger tablets may be difficult for some and with age, as our swallowing muscle gets weaker, it might pose some challenge.

Swallowing is harder when lying down. That’s why we eat and drink sitting upright. If there is irritation at the back of your throat while lying down, it could be related to acid reflux. If you have acid reflux, avoid acidic and spicy food that can irritate the sensitive lining of the throat. Avoid late dinner and try not to lie down within 3 hours after eating a meal.

If your symptoms worsen, I suggest getting a referral to see an ENT doctor for a review and speech therapist for swallowing assessment.

2. Question by Brendan

Hi Dr Ng,

I’ve been having the fear of swallowing and choking. But I am only 39years old.

My psychiatrist says this is because of anxiety. Is it common to have dysphagia at such a young age? How do I help myself get better?

Thank you for your advice.

Answer by Dr Christina Ng

Hi Brendan, yes, anxiety can cause difficulty swallowing.

It would be reasonable to continue with your psychiatry review to optimise the anxiety treatment. The fear of swallowing and choking should get better once the anxiety is better managed.

3. Question by Caroline

Good day Dr Ng.

I'm a senior and is it normal to produce less saliva as we age and that's why my tongue seems to be stuck to the roof of my mouth?

Following my recovery after I caught a bug and was coughing for about two weeks, my throat felt constricted. So just drink more water? Thank you.

Answer by Dr Christina Ng

Hi Caroline, yes, as we age, it is common for us to produce less saliva. On top of that, many older adults take medications that can dry out the mouth.

Dry tongue can cause the tongue to stick to the mouth lining more easily.

After an upper respiratory tract infection, there could be lingering irritation of the throat lining from the infection. It would take some time for the irritation to resolve.

Adequate hydration is essential in your recovery especially after a bout of infection.

4. Question by Peter

Hi Dr,

While I do not have a specific swallowing issue, I do from time-to-time experience severe hiccups as food travels down my oesophagus – this despite hydration before and during meals, and also in the middle of a meal.

The hiccup description is not a reference to the sound it makes, but more a spasmodic reaction of the oesophagus as the food travels down.

Does not happen during every meal, but it does occur 1-2 a week.

I’m male, 62 years old and did have a history of acid reflux, although that has been in remission for more than a decade.

Had an unremarkable endoscopy with no issues. Had high cholesterol, was pre-diabetic and high BP, but reversed everything through diet and exercise within the first half of this year.

Many thanks for your consideration and time.

Answer by Dr Christina Ng

Hi Peter, thank you for your question. This is an interesting issue.

Hiccups can occur due to many factors including eating too fast or too much, eating spicy food, drinking alcoholic or carbonated beverages.

I suggest recording the meals you had that resulted in the hiccups to find the reason for the hiccups.

If the hiccups become severe or persistent affecting your ability to eat or sleep, please seek medical help.

5. Question by Brenda

Dear Doctor,

I am 67 years old. I have this feeling of a lump in the throat for a couple of years, I can eat but have problem swallowing big capsules (like omega oil) as I feel capsule may get stuck in the throat.

Before this problem I can swallow big pills without fear. Many times I felt like my throat is being pressed upon, but actually nothing is there.

Hope to hear from you soon. Thank you for your advice.

Answer by Dr Christina Ng

Hi Brenda, this feeling of a lump in the throat sensation can be due to a few reasons.

It is commonly related to acid reflux. Acid reflux irritates the throat lining causing this lump in the throat sensation.

If you have other symptoms such as heartburn, phlegm in the throat, frequent throat clearing or sore throat, that could be related to acid reflux.

Treatment of reflux involves lifestyle changes and medications. Lifestyle changes such as avoiding acidic and spicy food that can irritate the sensitive lining of the throat.

Limit caffeine and alcohol as these can weaken the esophageal sphincter – the muscle that usually keeps stomach contents from refluxing – allowing acid and digestive enzymes to flow back into the throat.

Eating habits are also important. Eat smaller, more frequent meals to avoid over-distending your stomach. Avoid lying down 3 hours after eating a meal.

If the lump in throat sensation is still persistent despite the lifestyle changes, I suggest getting a referral for ENT review.

Ref: G25