Swallowing Difficulty (Dysphagia): Causes, Warning Signs and When to See an ENT Specialist

Swallowing Difficulty (Dysphagia): What Causes It and When Should You Be Concerned?

Most people swallow hundreds of times every day without noticing. When swallowing becomes uncomfortable, difficult or feels abnormal, it can quickly affect eating, drinking and quality of life.

Some patients describe food “sticking” in the throat, while others notice coughing during meals, discomfort swallowing tablets or a persistent sensation of tightness in the throat.

The medical term for swallowing difficulty is dysphagia.

Swallowing problems can range from mild irritation to more significant conditions requiring specialist investigation. This article explains common causes of dysphagia, symptoms to look out for and when to seek ENT assessment.

What is dysphagia?

Dysphagia means difficulty swallowing.

It may involve problems with:

Swallowing solids
Swallowing liquids
Initiating a swallow
Sensation of food sticking
Pain during swallowing
Coughing or choking while eating

Symptoms may occur occasionally or worsen over time.

What does swallowing normally involve?

Swallowing is a complex process involving the:

Mouth
Tongue
Throat muscles
Voice box (larynx)
Food pipe (oesophagus)

These structures must work together in a coordinated way to move food safely from the mouth into the stomach while protecting the airway.

Problems affecting any stage of this process can lead to dysphagia.

Common symptoms of swallowing difficulty

Patients may describe:

Food sticking in the throat
Difficulty swallowing tablets
Coughing during meals
Needing repeated swallows
Pain when swallowing
Weight loss
Avoiding certain foods
Sensation of a lump in the throat
Regurgitation of food
Voice changes after eating

Some people also develop recurrent throat clearing or chronic cough.

Common causes of dysphagia

1. Laryngopharyngeal reflux (silent reflux)

Reflux can irritate the throat and voice box, leading to inflammation and discomfort during swallowing.

Symptoms may include:

Globus sensation
Throat clearing
Hoarse voice
Chronic cough
Burning throat discomfort
Bitter taste or reflux symptoms

Reflux-related irritation may fluctuate and often worsens after meals or when lying flat.

2. Globus sensation and throat muscle tension

Some patients feel a persistent “lump” in the throat despite swallowing normally.

This is called globus sensation.

It may be associated with:

Reflux
Stress or anxiety
Muscle tension
Chronic throat irritation
Frequent throat clearing

Although usually benign, persistent symptoms should still be assessed carefully.

3. Inflammation or infection

Conditions affecting the throat or tonsils can temporarily make swallowing painful.

Examples include:

Tonsillitis
Viral throat infections
Pharyngitis
Ulcers or inflammation

Most infectious causes improve with time, but persistent symptoms may require further assessment.

4. Structural narrowing or obstruction

Occasionally, narrowing within the throat or oesophagus can cause food to stick.

Symptoms may gradually worsen over time and may initially affect solid foods before liquids.

Investigation is particularly important if symptoms are progressive.

5. Neurological or muscle-related conditions

Swallowing can also be affected by conditions involving the nerves or muscles controlling the throat.

These may lead to:

Choking episodes
Coughing while eating
Difficulty coordinating swallowing
Aspiration (food entering the airway)

Some patients may require multidisciplinary assessment.

Could swallowing problems affect the airway?

Yes. Some patients with dysphagia may accidentally inhale food or fluids into the airway.

This can lead to:

Coughing during meals
Chest infections
Voice changes after swallowing
Breathlessness during eating

Persistent choking or aspiration symptoms should not be ignored.

When should you see an ENT specialist?

You should seek ENT assessment if you have:

Persistent swallowing difficulty
Food sticking in the throat
Pain when swallowing
Ongoing globus sensation
Hoarse voice
Chronic throat clearing
Recurrent choking episodes
Weight loss
Smoking history with throat symptoms
Symptoms lasting several weeks

Swallowing symptoms should always be assessed carefully if they are worsening or associated with weight loss.

How is dysphagia investigated?

Detailed history

Assessment includes discussion of:

Type of swallowing difficulty
Solids versus liquids
Duration of symptoms
Weight changes
Reflux symptoms
Smoking history
Voice changes
Coughing or choking episodes

Examination of the throat and neck

The mouth, throat and neck are examined carefully for swelling, inflammation or abnormalities.

Flexible nasendoscopy

A thin flexible camera may be passed gently through the nose to examine the throat and voice box.

This allows assessment of:

Vocal cords
Swallowing structures
Signs of reflux
Pooling of saliva or mucus
Structural abnormalities

The procedure is usually quick and well-tolerated.

Additional tests

Some patients may require further investigations, such as:

Swallowing studies
Imaging scans
Barium swallow tests
Endoscopy of the oesophagus
Speech and language therapy assessment

The choice of tests depends on symptoms and examination findings.

Treatment options for swallowing difficulty

Treatment depends on the underlying cause.

Reflux management

This may include:

Avoiding late-night meals
Reducing caffeine and alcohol
Weight management where appropriate
Acid-reducing medication
Dietary modification

Swallowing therapy

Speech and language therapists can help improve swallowing coordination and safety in selected patients.

Voice and throat care

Patients may benefit from:

Good hydration
Reducing throat clearing
Managing allergies or nasal symptoms
Voice therapy if muscle tension contributes

Surgical or procedural treatment

In selected cases, procedures may be needed to address structural narrowing or other abnormalities.

Management is individualised depending on the diagnosis.

Safety-netting: when to seek urgent medical attention

Seek urgent medical help if you develop:

Difficulty breathing
Inability to swallow saliva
Sudden complete blockage when eating
Severe choking episodes
Coughing up blood
Rapidly worsening swallowing difficulty
Significant unexplained weight loss
Persistent neck swelling
Severe pain with swallowing

For severe breathing or choking symptoms, seek emergency medical assistance immediately.

Why choose Mr Gaurav Kumar for swallowing and throat assessment?

Mr Gaurav Kumar is a Consultant ENT Surgeon with experience in assessing:

Swallowing difficulty (dysphagia)
Globus sensation
Chronic throat clearing
Hoarse voice
Laryngopharyngeal reflux
Chronic cough
Voice disorders
Throat discomfort and swallowing concerns

Patients can access consultant-led ENT assessment in London and Essex with tailored investigation and management plans based on their symptoms and examination findings.

Book a swallowing and throat consultation in London or Essex

If you have persistent swallowing difficulty, globus sensation, throat clearing or voice changes, a specialist ENT assessment can help identify the underlying cause and guide treatment.

To arrange a consultation with Mr Gaurav Kumar, please contact the practice team or use the online booking system.

This article is for general information only and does not replace personalised medical advice. If symptoms are severe, progressive or associated with breathing difficulty, seek urgent medical care.

Call 07494914140
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