Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. It can cause a wide variety of symptoms, including issues with vision, sensation, movement, balance, and thinking. Some people with MS also experience throat symptoms like swallowing problems, vocal cord dysfunction, or throat pain.
Swallowing Problems
One of the most common throat issues seen in MS is difficulty swallowing, known medically as dysphagia. Estimates vary, but dysphagia may affect anywhere from 33-43% of people with MS at some point during the course of their disease.
Dysphagia occurs when there is a problem with the muscles, nerves or structures involved in chewing food and moving it from the mouth down to the stomach. In MS, dysphagia is usually caused by damage to the nerves that control the muscles involved in swallowing. This damage disrupts the complex coordination required for normal swallowing function.
Some common symptoms of dysphagia in MS include:
- Coughing or throat clearing during or after eating/drinking
- Gagging or choking when swallowing
- Feeling that food is sticking in your throat or chest
- Needing to swallow multiple times to clear food from the throat
- Drooling due to inability to swallow saliva
- Taking a long time to chew or eat
- Unintentional weight loss from eating less due to swallowing difficulties
In some cases, dysphagia can also increase the risk of aspiration, which is when food, saliva, or liquids accidentally enter the airway instead of the esophagus. This can potentially lead to aspiration pneumonia, a lung infection caused by inhaling foreign material into the lungs.
Assessing Dysphagia
There are a few different methods doctors can use to evaluate dysphagia in MS patients:
- Clinical swallow evaluation: This involves an assessment of the oral, pharyngeal, and esophageal phases of swallowing. The clinician will observe your swallowing function as you eat and drink material of various textures.
- Fiberoptic endoscopic evaluation of swallowing (FEES): This test uses a flexible endoscope inserted through the nose to view swallowing mechanisms and identify any abnormalities.
- Videofluoroscopic swallow study: This radiologic test records a video of swallowed material mixed with barium to observe the swallowing process and identify any dysfunction, obstruction, or aspiration.
- Manometry: Measures muscle pressures and coordination involved in swallowing using small tubes with pressure sensors placed in the throat.
Treating Dysphagia
If swallowing problems are identified, there are various treatment approaches that can help:
- Diet modifications: Your doctor may recommend altering food textures or liquid thicknesses to make swallowing easier and safer.
- Postural changes: Tilting your head forward or turning it toward the weaker side when swallowing can help protect the airway.
- Swallowing maneuvers: Certain techniques, like a suppressed cough or Mendelsohn maneuver, can improve muscle strength and coordination for swallowing.
- Medications: Drugs can help treat some underlying causes of dysphagia, such as decreasing excess saliva production.
- Swallowing therapy: Working with a speech-language pathologist to strengthen oral and throat muscles through specific exercises.
In very severe cases where dysphagia cannot be adequately managed, alternative feeding methods may be needed, such as a feeding tube. However, for most MS patients, dysphagia can be improved with the right strategies and interventions.
Vocal Cord Dysfunction
Vocal cord dysfunction, also known as paradoxical vocal fold motion dysfunction, is another throat issue that can occur with MS. It involves a problem with the vocal cords that causes them to improperly close when breathing in.
Normally, the vocal cords open wide to allow air to pass during inhalation and exhalation. But in vocal cord dysfunction, the vocal cords spasm closed when inhaling, blocking some airflow. This results in symptoms like:
- Stridor – high-pitched, noisy breathing
- Shortness of breath
- Difficulty taking deep breaths
- Tightness in the throat
- Coughing or throat clearing
The exact cause of vocal cord dysfunction in MS is not known. It may occur due to impaired signaling between the brain and nerves that activate the vocal cord muscles. Anxiety or stress can also contribute to flare ups of symptoms.
Diagnosis and Treatment
Vocal cord dysfunction is often initially mistaken for asthma, so the first step is a thorough exam by an otolaryngologist to rule out other conditions. They may use visualization tests like laryngoscopy to view abnormal vocal cord motion during breathing.
Treatment focuses on managing symptoms. Speech therapy can help retrain vocal cord motion. Breathing control techniques and relaxation strategies may be beneficial. In severe cases, surgery is an option to open the airway.
Oropharyngeal Dysphagia
Oropharyngeal dysphagia refers to difficulty in initially moving food from the mouth back into the throat (the oropharynx area). This happens when MS damages the cranial nerves that control the muscles of the mouth and throat.
Oropharyngeal dysphagia can cause symptoms like:
- Drooling
- Food or liquid leaking from the mouth
- Coughing or choking when swallowing
- Pooling of food in the mouth after swallowing
- Needing multiple swallows to clear food
- Nasal regurgitation
Speech therapy is important for addressing oropharyngeal dysphagia. Exercises can help strengthen the oral and pharyngeal muscles. Compensatory strategies, like a chin tuck maneuver when swallowing, can also help protect the airway.
Laryngospasm
Laryngospasm is an uncontrolled spasm of the vocal cords that causes them to completely close for a short time. It results in a temporary inability to breathe or speak. Laryngospasm can occur in MS patients due to impaired signaling between the brain and nerves controlling the vocal cords.
The symptoms usually only last up to 60 seconds, but can be quite scary and include:
- Feeling unable to breathe in
- Noisy gasping for breath
- Turning blue from lack of oxygen
- Panic or feeling of choking
Treatment involves remaining calm and breathing slowly to relax the vocal cords. In some cases, medication may be used to reduce spasms. Identifying and avoiding triggers is also recommended.
Throat Pain
Some people with MS experience recurring throat pain or soreness. This can result from inflammation in throat muscles or nerves caused by MS lesions. Throat pain associated with MS may feel like:
- Burning or stinging
- Feeling of lump or tightness
- Rawness or irritation
- Sharp, shooting pain
- Dull aching
It may be triggered or worsened by swallowing, talking, coughing, or moving the head and neck in certain ways. Throat lozenges, cold beverages, saltwater gargles, and over-the-counter pain medication can provide temporary relief in many cases.
When to See a Doctor
You should consult a doctor if throat pain:
- Persists for more than 1-2 weeks
- Worsens or spreads
- Is severe or interfering with eating/drinking
- Occurs with other concerning symptoms like difficulty breathing
This can help identify and properly treat any underlying condition causing the throat pain.
Speech Changes
MS can sometimes contribute to speech problems like:
- Dysarthria – Slurred, slow, or garbled speech
- Spasmodic dysphonia – Strained or choked speech with altered pitch
- Scanning speech – Abnormally separated syllables
This occurs when MS lesions affect the areas of the brain involved in speech motor control. Other symptoms may include rapid speech rate, poor articulation, or a hoarse, breathy voice.
Working with a speech-language pathologist on exercises to improve breath support, articulation, vocal quality and volume can help manage these speech changes.
When to See a Doctor
It’s recommended to consult a doctor promptly if you experience any new throat symptoms like:
- Pain or burning in the throat
- Difficulty swallowing
- Frequent choking or coughing when eating/drinking
- Hoarse voice
- Shortness of breath
Early evaluation and treatment of throat issues can prevent complications. Be sure to tell your doctor about all medications you are taking, since some can also contribute to throat problems.
Managing Throat Problems
Here are some tips for managing throat symptoms associated with MS:
- Stay hydrated by sipping cool water throughout the day
- Suck on lozenges to soothe throat irritation or pain
- Try over-the-counter throat sprays or gargles
- Use a humidifier to add moisture to the air, especially at night
- Eat soft, smooth foods that are easy to swallow
- Avoid irritants like smoke, pollution, and chlorinated water
- Practice relaxation techniques to reduce strain on the throat
- Learn compensation strategies from a speech therapist
If your throat symptoms start severely impacting your ability to eat, drink, or breathe, seek prompt medical attention.
Conclusion
Throat dysfunction is relatively common in those with MS. The most frequently reported problems involve swallowing, vocal cord function, and throat pain. Speech impairments may also occur in some patients. Addressing any throat issues quickly is key to limiting complications and restoring normal function as much as possible.
While throat symptoms can be frustrating to deal with, there are treatments available ranging from diet changes to medication to therapy. Working closely with your neurologist and related specialists ensures you have the right support to successfully manage throat problems from MS.
| Type of Throat Problem | Common Symptoms | Treatment Approaches |
|---|---|---|
| Dysphagia (trouble swallowing) | Coughing/choking when eating or drinking, gagging, food sticking, weight loss | Diet changes, postural strategies, swallowing maneuvers/exercises, medications, feeding tube (severe cases) |
| Vocal cord dysfunction | Stridor, shortness of breath, throat tightness, difficulty inhaling | Speech therapy, breathing techniques, relaxation methods, surgery (severe cases) |
| Oropharyngeal dysphagia | Drooling, food/liquid leaking from mouth, choking, nasal regurgitation | Oral and pharyngeal muscle strengthening exercises |
| Laryngospasm | Unable to breathe in, noisy gasping, turning blue, feeling of choking | Staying calm, breathing slowly, medication for spasms, avoid triggers |
| Throat pain | Burning, stinging, lump feeling, rawness, sharp/dull pain | Throat lozenges, cold drinks, salt water gargles, OTC pain medication |