dysphagia

If you have a swallowing disorder, you may have difficulty or pain when swallowing. Some people cannot swallow at all. Others may have trouble swallowing liquids, foods, or saliva. This makes it hard to eat. Often, it can be difficult to take in enough calories and fluids to nourish your body.

Anyone can have a swallowing disorder, but it is more common in older adults. It often happens because of other conditions, including:

• Nervous system disorders, such as Parkinson's disease and cerebral palsy
• Problems with your esophagus, including GERD (gastroesophageal reflux disease)
• Stroke
• Head or spinal cord injury
• Cancer of the head, neck, or esophagus

Medicines can help some people, while others may need surgery. Swallowing treatment with a speech-language pathologist can help. You may find it helpful to change your diet or hold your head or neck in a certain way when you eat. In very serious cases, people may need feeding tubes.

NIH: National Institute on Deafness and Other Communication Disorders

The chest is the part of your body between your neck and your abdomen (belly). The medical term for your chest is thorax.

Your chest holds many important structures for breathing, digestion, blood circulation, and other important body functions. These structures include your:

• Ribs and breastbone
• Esophagus, the tube between your mouth and stomach
• Trachea, your windpipe
• Bronchi, the tubes that carry air from your windpipe to your lungs
• Lungs
• Pleura, a thin layer of tissue that covers the lungs and lines the inside wall of the chest space
• Heart and large blood vessels
• Thymus, a gland that's part of your immune system
• Nerves

Chest injuries and disorders are problems that affect any of the organs or structures located in your chest.

There are many types of chest injuries and disorders, for example:

• Broken ribs
• Esophagus disorders
• Swallowing disorders, also called dysphagia
• Tracheal disorders
• Bronchial disorders
• Lung diseases and collapsed lung
• Pleural disorders
• Heart diseases
• Mediastinal diseases, which are tumors, inflammation, and other problems with the structures in the mediastinum, which is the space between your lungs, breastbone, and spine
• Thoracic aortic aneurysm
• Thoracic outlet syndrome

Chest injuries may happen from the force of car accidents, falls, or sports injuries. Or the chest may be pierced by a bullet or sharp object. Because your chest holds so many important structures, certain chest injuries may be life-threatening.

Diagnosis of chest injuries or disorders depends on the type of symptoms you're having and whether you've had a chest injury. Injuries are usually obvious, but in most cases, you'll need tests to know how serious an injury is.

There are many types of tests for diagnosing different types of chest injuries and disorders, for example:

• Diagnostic imaging tests
• Heart tests
• Lung function tests
• Bronchoscopy
• Pleural fluid analysis
• Dysphagia tests
• Biopsy

Treatments will depend on the type of chest injury or disorder you have.

A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of the damage. Rehabilitation can help them relearn those skills.

The effects of a stroke depend on which area of the brain was damaged. The types of disabilities a stroke can cause include:

• Paralysis or problems controlling movement
• Pain and other problems with the senses
• Problems using or understanding language
• Problems with thinking and memory
• Emotional disturbances

Stroke rehabilitation involves many kinds of health professionals. The goal is to help stroke survivors become as independent as possible and to have the best possible quality of life.

NIH: National Institute of Neurological Disorders and Stroke

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

Symptoms of a TBI can be mild, moderate, or severe. Concussions are a type of mild TBI. The effects of a concussion can sometimes be serious, but most people completely recover in time. More severe TBI can lead to serious physical and psychological symptoms, coma, and even death.

The main causes of TBI depend on the type of head injury:

• Some of the common causes of a closed head injury include
  • Falls. This is the most common cause in adults age 65 and older.
  • Motor vehicle crashes. This is the most common cause in young adults.
  • Sports injuries
  • Being struck by an object
  • Child abuse. This is the most common cause in children under age 4.
  • Blast injuries due to explosions
• Some of the common causes of a penetrating injury include
  • Being hit by a bullet or shrapnel
  • Being hit by a weapon such as a hammer, knife, or baseball bat
  • A head injury that causes a bone fragment to penetrate the skull

Some accidents such as explosions, natural disasters, or other extreme events can cause both closed and penetrating TBI in the same person.

Certain groups are at higher risk of TBI:

• Men are more likely to get a TBI than women. They are also more likely to have serious TBI.
• Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI

The symptoms of TBI depend on the type of injury and how serious the brain damage is.

The symptoms of mild TBI can include:

• A brief loss of consciousness in some cases. However, many people with mild TBI remain conscious after the injury.
• Headache
• Confusion
• Lightheadedness
• Dizziness
• Blurred vision or tired eyes
• Ringing in the ears
• Bad taste in the mouth
• Fatigue or lethargy
• A change in sleep patterns
• Behavioral or mood changes
• Trouble with memory, concentration, attention, or thinking

If you have a moderate or severe TBI, you may have those same symptoms. You may also have other symptoms such as:

• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Not being able to wake up from sleep
• Larger than normal pupil (dark center) of one or both eyes. This is called dilation of the pupil.
• Slurred speech
• Weakness or numbness in the arms and legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible. To make a diagnosis, your health care provider:

• Will ask about your symptoms and the details of your injury
• Will do a neurologic exam
• May do imaging tests, such as a CT scan or MRI
• May use a tool such as the Glasgow coma scale to determine how severe the TBI is. This scale measures your ability to open your eyes, speak, and move.
• May do neuropsychological tests to check how your brain is functioning

The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury.

For mild TBI, the main treatment is rest. If you have a headache, you can try taking over-the-counter pain relievers. It is important to follow your health care provider's instructions for complete rest and a gradual return to your normal activities. If you start doing too much too soon, it may take longer to recover. Contact your provider if your symptoms are not getting better or if you have new symptoms.

For moderate to severe TBI, the first thing health care providers will do is stabilize you to prevent further injury. They will manage your blood pressure, check the pressure inside your skull, and make sure that there is enough blood and oxygen getting to your brain.

Once you are stable, the treatments may include:

• Surgery to reduce additional damage to your brain, for example to
  • Remove hematomas (clotted blood)
  • Get rid of damaged or dead brain tissue
  • Repair skull fractures
  • Relieve pressure in the skull
• Medicines to treat the symptoms of TBI and to lower some of the risks associated with it, such as
  • Anti-anxiety medication to lessen feelings of nervousness and fear
  • Anticoagulants to prevent blood clots
  • Anticonvulsants to prevent seizures
  • Antidepressants to treat symptoms of depression and mood instability
  • Muscle relaxants to reduce muscle spasms
  • Stimulants to increase alertness and attention
• Rehabilitation therapies, which can include therapies for physical, emotional, and cognitive difficulties:
  • Physical therapy, to build physical strength, coordination, and flexibility
  • Occupational therapy, to help you learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
  • Speech therapy, to help you to with speech and other communication skills and treat swallowing disorders
  • Psychological counseling, to help you learn coping skills, work on relationships, and improve your emotional well-being
  • Vocational counseling, which focuses on your ability to return to work and deal with workplace challenges
  • Cognitive therapy, to improve your memory, attention, perception, learning, planning, and judgment

Some people with TBI may have permanent disabilities. A TBI can also put you at risk for other health problems such as anxiety, depression, and post-traumatic stress disorder. Treating these problems can improve your quality of life.

There are steps you can take to prevent head injuries and TBIs:

• Always wear your seatbelt and use car seats and booster seats for children
• Never drive under the influence of drugs or alcohol
• Wear a properly fitting helmet when riding a bicycle, skateboarding, and playing sports like hockey and football
• Prevent falls by
  • Making your house safer. For example, you can install railings on the stairs and grab bars in the tub, get rid of tripping hazards, and use window guards and stair safety gates for young children.
  • Improving your balance and strength with regular physical activity

The esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. You may not be aware of your esophagus until you swallow something too large, too hot, or too cold. You may also notice it when something is wrong. You may feel pain or have trouble swallowing.

The most common problem with the esophagus is GERD (gastroesophageal reflux disease). With GERD, a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it. Over time, GERD can cause damage to the esophagus.

Other problems include heartburn, cancer, and eosinophilic esophagitis. Doctors may use various tests to make a diagnosis. These include imaging tests, an upper endoscopy, and a biopsy.

Treatment depends on the problem. Some problems get better with over-the-counter medicines or changes in diet. Others may need prescription medicines or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Your mouth is one of the most important parts of your body. It has many different functions. It allows you to:

• Take in food and drink
• Breathe in air
• Start digestion, with your teeth chewing the food you eat and your salivary glands releasing saliva to help break down the food
• Speak and sing
• Show emotion, by smiling or pouting

Any problem that affects your mouth can make it hard to eat, drink, or even smile. Some common mouth problems include:

• Cold sores - painful sores on the lips and around the mouth, caused by a virus
• Canker sores - painful sores in the mouth, caused by bacteria or viruses
• Thrush - a yeast infection that causes white patches in your mouth
• Leukoplakia - white patches of excess cell growth on the cheeks, gums or tongue, common in smokers
• Dry mouth - a lack of enough saliva, caused by some medicines and certain diseases
• Gum or tooth problems
• Bad breath

Treatment for mouth disorders varies, depending on the problem. If a mouth problem is caused by some other disease, treating that disease can help. It is also important to keep your mouth clean and healthy by brushing, flossing, and not using tobacco.

Your throat is a tube that carries food to your esophagus and air to your windpipe and larynx. The technical name for your throat is the pharynx.

Throat problems are common. You've probably had a sore throat. The cause is usually a viral infection, but other causes include allergies, infection with strep bacteria or the leaking of stomach acids back up into the esophagus, called GERD.

Other problems that affect the throat include:

• Tonsillitis - inflammation of the tonsils
• Cancer
• Croup - inflammation, usually in small children, which causes a barking cough
• Laryngitis - swelling of the voice box, which can cause a hoarse voice or loss of voice

Most throat problems are minor and go away on their own. Treatments, when needed, depend on the problem.