Sense of suffocation when swallowing

Specialty: Respiratory.

• suffocation swallowing
• post-swallowing drowning
• laryngotracheal aspiration

Why it occurs

• Cricopharyngeal dysfunction or achalasia of the upper esophageal sphincter (failure to relax the sphincter that causes stagnation of the bolus in the hypopharynx and subsequent overflow into the airway)
• Myasthenia gravis or amyotrophic lateral sclerosis (weakness of the pharyngeal and laryngeal muscles with ineffective glottic closure during swallowing)
• Sequelae of brainstem cerebrovascular accident (CVA) (pseudobulbar palsy with abolition of the protective airway reflex)
• Large Zenker's diverticulum (accumulation of food in the diverticular pouch that is passively regurgitated and aspirated when adopting certain postures)
• Unilateral vocal cord paralysis (incomplete glottic closure that allows fluids to pass into the trachea).

Initial workup

Videofluoroscopy of swallowing or modified barium swallow (gold standard to evaluate the swallowing mechanism and document silent or overt aspiration); Nasofibrolaryngoscopy with sensory evaluation of swallowing (FEES); Upper digestive endoscopy; High resolution esophageal manometry.

Standard management

• Management is fundamentally rehabilitative through safe swallowing techniques and adaptation of the consistency of foods with thickeners.
• Pyridostigmine — acetylcholinesterase inhibitor, 60 mg orally every 6 hours for confirmed myasthenia gravis
• Botulinum toxin (localized injection in the cricopharyngeal muscle performed by a specialist in selected cases of sphincter dysfunction).