[MUSIC PLAYING] At University of Virginia Health System, we are for bringing advanced care closer to home. So we're bringing health knowledge directly to you with UVA Health System Radio. Here's Melanie Cole. 

Swallowing is complex. And a number of conditions can interfere with this process. What are the most common causes of swallowing problems? And what treatments are available to help? 

My guest today is Dr. James Daniero. He's a board certified otolaryngologist head and neck surgeon who specializes in caring for patients with voice and swallowing conditions. Welcome to the show, Dr. Daniero. What are the most common causes of swallowing problems? 

Yes, well first of all, thank you, Melanie, for having me on the show. The most common cause of swallowing problems typically happen to the elderly population. And that involves stroke neurodegenerative diseases, such as Parkinson's disease, dementia, and ALS, or Lou Gehrig's disease. 

It can be also a consequence of radiation for treatment of other disorders, primarily head and neck cancer, as well as neck surgery or neck trauma. 

So these causes, these things are happening in the elderly and because of diseases. So you've explained to us the people that are most likely to be affected. How do swallowing problems affect the quality of life? And what might signal that this is actually happening? 

Because sometimes we all feel, Dr. Daniero, a little lump in our throat. Or we have trouble getting something down. So what distinguishes this to something that would say you need to see the doctor about this? 

Well, sure. Quality of life is a huge issue for patients with swallowing disorders. And the particular signs that this is becoming a more significant problem that needs evaluation by someone who treats swallowing disorders would be weight loss or recurrent pneumonia. Those type of things are really the most severe consequences of swallowing disorders. 

Now, it is very common for patients to complain of difficulty swallowing with a lump in their throat. And if that's persistent, if that is a recurrent problem, then that would also warrant evaluation. 

How is this diagnosed? What do you do to diagnose a swallowing problem? 

Sure. I think the primary thing, the best thing I have to look at swallowing problems is talking with the patient. It's just getting a good what we call a history, the onset and the type of symptoms. When I talk with patients, I ask them what kind of foods are they having trouble with. And what particular situation do they describe that they're having trouble swallowing in. And that really narrows me in. 

Primarily, there's two different types of swallowing disorders. One is swallowing disorders related to liquids. And that's a whole different set of problems than those are related to solid foods, such as meats or breads that people will complain of difficulty with. 

So if you've diagnosed somebody with one of these swallowing problems, what treatments are available out there? 

Depending on the cause, then there is a number of different causes for the swallowing problem. But treatment can be broken down into a couple of main categories. One is a medical and therapy treatment. And that is why I actually work along with a speech pathologist in clinic. And we can often provide some of that treatment right in the same day as the visit. 

And working with the speech pathologist, there can be different maneuvers, as far as swallowing, that can assist them in their swallowing trouble, as well as modifying the diet to different consistencies, thickened liquids, or softer pureed type food and different conservative things. 

The other category, the main category, and what I'm typically involved in, when the speech pathologist isn't able to make those adjustments for a safe swallow, then it becomes the surgical option. 

And I perform endoscopic surgeries. And that's all through the mouth, without incisions in the neck, and usually a faster recovery. If they're not candidates for the endoscopic approach, then I also perform an open surgery with incision through the neck to address some of the swallowing disorders. 

What is that surgery like? People would hear about swallow surgery and get very nervous, get scared. It sounds very scary. Because this is your ability to eat, and to talk, and so it's really a sensitive area. Tell us a little bit about the surgery. 

Sure. So the newer approaches, and what I am actually a specialist in, is the endoscopic approaches. This is, within the past 20 years, we've really revolutionized the way we treat swallowing disorders and now have incisionless was surgery, a minimally invasive approach. 

And for patients, it typically involves coming in to the hospital, spending a night over in the hospital, but going home the next morning and then generally, with almost immediate relief. The relatively limited pain, most patients complain they have a sore throat, like they had a strep throat or something. And then they are back on to swallowing with usually, impressive results. 

Wow. And is this something that is likely to reoccur? What is the outcome from this type of surgery? 

There are certain types of surgery that tend to require more interventions. And those are things such as stretching the esophagus. And many people come in from saying that they have had a gastroenterologist or other doctor that has performed a stretching of their swallowing tube. That often will require repeated dilation or repeated stretching in order to have a long lasting benefit. 

The surgery that I particularly specialize in, where I use a laser and I actually cut muscle fibers that produce the swelling dysfunction, tends to be a permanent result. 

Wow, that's incredible. And now, what is, then, the eating outcome? Do they have to be on those thickened liquids for the rest of their life? Is there a possibility of needing a feeding tube? Or can they resume eating certain foods and salads? 

Depending on the problem, the people that are generally surgical candidates from the procedures I was talking about typically have trouble with the solid foods. And they're in that category primarily. Those patients can mostly resume a normal diet. And they are actually my favorite patients that the after surgery. Because they come in. And they are just so happy that they can resume a normal life. 

They can go out to eat again with their family members on Thanksgiving and other holidays. They now can enjoy the social interaction. And this is an at risk population for depression too. They are usually 65 and older. Half of this age group, half of the Americans 65 and older, will have swallowing trouble. 

And therefore when we can restore the ability to eat, it restores a lot of their ability to have social interaction. And they're at risk for depression as a result of social isolation. And we can cure that. 

That's amazing. And in just the last minute or so Dr. Daniero, why should patients come to UVA for treatment of their swallowing problems? 

One thing for patients to look for when they're evaluating a place for a possible treatment of their swallowing problem is to look for someone who is a fellowship trained laryngologist. And that's some of the training that I received. That is an otolaryngologist, or an ear, nose, and throat doctor, that specializes in voice and swallowing and has special training regarding that. 

There's only a handful of providers in the state of Virginia that provide this service and have this designation, of which UVA is one of them. We also have a team approach to swallowing disorders. And I have a voice and swallowing specialized clinic, which I work with a speech and language pathologist. 

And we can perform some of the swallowing evaluation right in clinic on the same day. We can even perform in-office surgeries for swallowing disorders, where the patient doesn't have to be admitted to the hospital. And they can come in and out. They can even drive themselves to their own appointment to have these procedures. Because there's no sedation or anesthesia, other than just numbing the throat. 

Wow, thank you so much, Dr. James Daniero. And for more information, you can go to UVAHealth.com. That's UVAHealth.com. You're listening to UVA Health System Radio. This is Melanie Cole. Have a great day. 

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