Several factors contribute to swallowing problems:

• With age, swallowing muscles often lose strength and coordination. Thus, even normal secretions may not pass smoothly into the stomach.
• During sleep, swallowing occurs much less frequently, and secretions may gather. Coughing and vigorous throat clearing are often needed when awakening.
• When nervous or under stress, throat muscles can trigger spasms that feel like a lump in the throat. Frequent throat clearing, which usually produces little or no mucus, can make the problem worse by increasing irritation.
• Growths or swelling in the food passage can slow or prevent the movement of liquids and/or solids.

Swallowing problems may be caused also by gastroesophageal reflux disease (GERD). This is a return of stomach contents and acid into the esophagus or throat. Heartburn, indigestion, and sore throat are common symptoms. GERD may be aggravated by lying down especially following eating. Hiatal hernia, a pouch-like tissue mass where the esophagus meets the stomach, often contributes to the reflux.

Chronic Sore Throat

Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.

Treatment

A correct diagnosis requires a detailed ear, nose, and throat exam and possible laboratory, endoscopic, and x-ray studies. Each treatment is different:

Bacterial infection, when present, is treated with antibiotics. These drugs may provide only temporary relief. In cases of chronic sinusitis, surgery to open the blocked sinuses may be required.

Allergy is managed by avoiding the cause if possible. Antihistamines and decongestants, cromolyn and steroid (cortisone type) nasal sprays, and other forms of steroids may offer relief. Immunotherapy (allergy shots) also may be helpful.

Gastroesophageal reflux is treated by elevating the head of the bed six to eight inches, avoiding foods and beverages for two to three hours before bedtime, and eliminating alcohol and caffeine from the daily diet. Antacids (e.g., Maalox®, Mylanta®, Gaviscon ®) and drugs that block stomach acid production (e.g., Zantac®, Tagamet®, Pepcid®) or more powerful medications may be prescribed. A trial treatment may be suggested before x-rays and other diagnostic studies are performed.