Ross A. Hauser, MD. 

• In this article, we will discuss the problems of swallowing difficulties as they relate to the diagnosis of cervical spine disorder or cervical instability caused by weakened, torn, damaged ligaments in the neck.
• Cervical instability in the neck has been linked to swallowing difficulties, diagnosed as cervicogenic dysphagia.
• Cervical instability has been linked to cervical spine nerve compression which can be an “unseen” cause of swallowing difficulties, esophageal spasms, and acid reflux.
• Cervicogenic dysphagia is not a problem that can be treated in isolation, it is likely one of a myriad of symptoms related to neck pain and neck hypermobility.

When a patient comes into our clinic with problems of swallowing difficulties, the swallowing difficulties are usually not a problem in isolation. The patient will describe a medical history as an injury, car accident, or degenerative bulging discs in the neck. Sometimes they will describe that swallowing difficulties, as well as other strange symptoms, came upon them suddenly and for “no reason.”

Sometimes we will hear a medical history that the person themselves call “bizarre” and further describe themselves as a “medical mystery.” People will describe the onset of symptoms that just happened “out of nowhere.”

When a patient comes into our clinic with problems of swallowing difficulties, the swallowing difficulties are usually not a problem in isolation. While patients may tell us of their swallowing difficulties, most come in with primary complaints of neck pain or neck instability, whiplash-associated disorders, or post-concussion syndrome. Swallowing difficulties may be accompanied by headaches, dizziness, hearing problems, severe muscle spasms in the neck, ear filling, and skipped names but just a few symptoms.

In this article, we will present research, clinical observation, and patient outcomes to suggest that treating instability in the cervical spine with regenerative proliferative injections can help many patients with swallowing difficulties.

Part 1: A link between cervical spine instability to swallowing difficulties used to be rarely acknowledged and for the most part ignored.

• It was clear that the patient’s swallowing difficulties were coming from the cervical spine.
• C2 Malrotation and swallowing difficulties.
• Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.
• C2 malrotation can cause swallowing difficulties.
• Even though I have neck problems I was sent for an endoscopy – Esophagogastroduodenoscopy.

Part 2 Surgery for swallowing difficulties – high risk – low reward? What about the bone spurs?

• Searching for clues when surgery and treatment fail to correct swallowing difficulties.
• Swallowing difficulties and Diffuse idiopathic skeletal hyperostosis – “an underappreciated phenomenon.”
• Diffuse idiopathic skeletal hyperostosis, bone spurs, and cervical spine surgery.
• Surgery for swallowing difficulties – high risk – low reward? What about the bone spurs?
• Does surgery cause swallowing difficulties?
• Many patients had developed compensatory strategies to manage or reduce the burden of these symptoms but lacked professional guidance from health care professionals.
• Longer-term Dysphagia after surgery – nerve blocks.

Part 3: Swallowing difficulties: A problem of autonomic nervous system dysfunction?

• Swallowing difficulties: A problem of glossopharyngeal and vagus nerve dysfunction?
• Swallowing difficulties: A problem of age-related neurologic degeneration?

Part 4: Swallowing difficulties: A problem of posture?

• There is a problem with the chewing muscles contributing to problems in your cervical spine and your entire posture

Part 5: Swallowing difficulties: TMJ Involvement with cervical instability

• TMJ tongue’s involvement in swallowing difficulties.
• There is no doubt that TMJ patients suffer from swallowing difficulties, but do they have cervical instability as well, and is this making swallowing more challenging?
• Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments.

Part 6: Treating Cervical Spine Instability is treating swallowing difficulties

• Conservative care treatments and other symptoms and conditions.
• Exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet.
• Hydration.
• Brain fog, breathing, and swallowing difficulty, dizziness, tinnitus.
• The problems of people with fibromyalgia and dysphagia.
• Research on cervical instability and Prolotherapy.

Part 1: A link between cervical spine instability to swallowing difficulties used to be rarely acknowledged and for the most part ignored.

The caption reads The three phases of swallowing. The vagus nerve is involved in all three phases of swallowing as it innervates most of the pharynx and larynx mucosal surfaces as well as the muscle that elevates the palate and causes the larynx to contract. As we will discuss below, compression or interruption of the vagus nerve signals caused by neck instability can lead to swallowing difficulties.

Swallowing is a complex process involving the coordinated interactions of a network of nerves and muscles. The muscles of the mouth, back of the throat (pharynx), and the top end of the esophagus (upper esophageal sphincter) are directly connected to the brain through the cranial nerves, including the vagus nerve, and can be affected by many neurological disorders.

In 2013, noted Croatian musculoskeletal researcher Vjekoslav Grgić published a paper linking cervical spine instability to swallowing difficulties. (1) He also noted that this association was rarely acknowledged and for the most part ignored. We are going to present research below that takes us to 2024 and see how much has changed in 11 years. Surprisingly, it will be not much.

Here is Dr. Grgić’s review summary. See if this sounds familiar to your own case:

“Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia) are chronic multisegmental/musculoskeletal dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes (bone spurs), anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis (extensive amount of calcification that occurs within the spinal ligaments in the condition), injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors.

According to our clinical observations, degenerative changes in the cervical discs and cervical facet joints and chronic musculoskeletal dysfunction of the cervical spine facet joints are disorders that can cause swallowing difficulties.

However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in the differential diagnosis.“

It was clear that the patient’s swallowing difficulties were coming from the cervical spine.

In this case review from the New York Chiropractic & Physiotherapy Centre, reported in the Clinical Medicine Insights. Case Reports, (2) the doctors acknowledged that when someone has swallowing difficulties this could be “salivary secretory disorders, poor oral motor coordination, neuromuscular weakness, neurodegenerative diseases, stroke, and structural changes, can result in swallowing disorders.” But here they presented a case that they found astounding enough to publish the results. What made this case so astounding? It was clear that the patient’s swallowing difficulties were coming from the cervical spine.

Listen to the case:

• An elderly woman with upper neck stiffness and dysphagia sought chiropractic treatment.
• Her radiographic findings suggested cervical spondylosis with a vertical atlantoaxial subluxation (C1-C2 instability causing unnatural movement in the vertebrae).
• Following 20 sessions of chiropractic treatment, the patient experienced complete relief from neck problems and difficulty in swallowing.

How did this happen?

• In this case, the brain stem could have been compressed by the odontoid process of the axis due to C1/2 instability.

The conclusion of all this?

• Cervicogenic dysphagia is a cervical cause of difficulty in swallowing.
• Cervical complaints in the context of dysphagia are mostly underestimated.

Cervicogenic dysphagia caused by cervical spine/neck instability is not underestimated. In this case, chiropractic care was able to help eliminate the swallowing difficulties. As we will discuss below in our office we will employ cervical curve correction techniques as well as Prolotherapy injections to provide strength and stability to the spinal ligaments and the supportive structures of the neck.

C2 Malrotation and swallowing difficulties

Ross Hauser, MD discusses C2 Malrotation and the symptoms associated with it, as well as why we like adjustments, curve correction, and Prolotherapy to help restore spinal integrity and resolve symptoms.

Video learning points:

The malrotation of the C2 vertebrae or the axis, is often what I call the Missing Link into what is causing a person’s symptoms.

• Rotated C2 can compress the vagus nerve which can cause digestive problems seen in some upper cervical instability patients.
• Rotated C2 can cause compression on the glossopharyngeal nerve which can cause dysfunction of the larynx muscles and cause swallowing difficulties.
• Rotated C2 can cause compression of the spinal accessory nerve causing cramping into the sternocleidomastoid muscle or the trapezius muscle and creating a situation of torticollis.
• Rotated C2 can cause compression and obstruct the right jugular vein causing increased brain pressure and problems of cognitive decline and mood disorders.
• Rotated C2 can compress the carotid sheath causing compression on jugular veins and carotid arteries causing intracranial hypertension.

Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.

In September 2021, the same doctors presented another case in the Journal of Family Medicine and Primary Care. (3) Here doctors described a “unique case.”

“Dysphagia (swallowing difficulty) is most often related to other health problems, including brain or spinal cord injury, neurological damage, neuromuscular disorders, and anatomical conditions. Dysphagia can have detrimental effects on pulmonary health and also impact nutritional intake. The right treatment depends on the cause established. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. This report describes a 53-year-old female patient with a sore throat, swallowing difficulty for solids, and acid reflux for 2 years. Radiographs revealed anterior osteophytic lipping (abnormal bony growth or spurs on the vertebrae) kyphosis of the cervical spine and thoracolumbar (right convex) scoliosis. After 6 months of chiropractic treatment, her complaints and spinal deformity were obviously resolved. Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.”

In May 2023 in the Journal of Medicine and Life (4) a case history is presented discussing the value of chiropractic treatments despite “a lack of evidence supporting its effectiveness.” In this case study, a 48-year-old male presented with swallowing difficulties for eight months. “He had a feeling of food stuck in his throat when eating hard food but without any pain when swallowing, and eventually, he could not swallow any dry food. He was diagnosed with dysphagia associated with an anxiety disorder and was treated with medication, but there was no improvement in his condition.”

Imaging studies revealed reduced cervical lordosis and levoscoliosis of the upper thoracic spine. “After nine months of conventional physiotherapy, the patient completely recovered from his symptoms, with significantly improved biomechanical parameters. This study highlights the potential mechanism of cervicogenic dysphagia and the effect of chiropractic treatment in managing it. Applying chiropractic treatment, including spinal manipulative therapy, instrument-assisted soft tissue manipulation, and mechanical traction, might bring a positive outcome for dysphagia patients with careful consideration.”

C2 malrotation can cause swallowing difficulties

In this x-ray from one of our patients, we can display C2 malrotation. The dotted center line represents where the center of the C2 should be. We see that the C2 is shifted far over. Restoring the C2 to its natural position can alleviate swallowing difficulties as well as many symptoms attributed to cervical spine instability.

Next is a video from Ross Hauser, MD., where cervical spine instability is associated with cervical nerve dysfunction.

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In this video, Ross Hauser, MD explains the functional dynamics and possible solutions to swallowing difficulties.

Eating and swallowing are complex behaviors involving volitional and reflexive activities of more than 30 nerves and muscles. To swallow something, the food has to pass from the mouth to the pharynx to the esophagus without going down the larynx into the lungs. If it goes down the larynx, it is called aspiration. Painful or difficulty swallowing is called dysphagia and can be caused by Atlantoaxial instability. Most of the major muscles that are related to swallowing once the food gets past the mouth are innervated by the cranial nerves that reside in the carotid sheath, just anterior to the upper cervical vertebrae.  The two nerves most involved in speech and swallowing are the glossopharyngeal (cranial nerve IX) and the vagus nerve (cranial nerve X).

Video Summary Transcript

Swallowing involves many of the cranial nerves: The image below focuses on the epiglottis (the skin flap that helps prevent choking) moves to cover it.

• Cranial Nerve V or the trigeminal nerve, involves the muscles of biting, chewing, and swallowing
• Cranial Nerve VII or the facial nerve which in addition to assisting in swallowing is involved with taste sensation and salivary glands
• Cranial Nerve X or the Vagus Nerve
  • The Vagus nerve plays a vital role in the pharyngeal phase of swallowing. This is what happens during this phase:
    • The vocal cords close the larynx to help keep food and liquids from entering the airway and lungs. As the larynx closes, the epiglottis (the skin flap that helps prevent choking) moves to cover it.
    • Patients with swallowing difficulties caused by a disruption in the pharyngeal phase may suffer from:
      • Coughing during swallowing
      • Breathing difficulties during swallowing
      • A choking sensation
      • A change in voice during swallowing
      • More severe cases may include food particles passing into the lungs and causing pneumonia-like symptoms or pneumonia itself.
• Cranial Nerve IX or glossopharyngeal nerve which moves muscles of the tongue and throat
• Cranial Nerve XII or the hypoglossal nerve controls muscles in the pharynx (throat) and helps move found out of the mouth to the esophagus.

All these nerves run around the front of the cervical spine’s vertebrae, especially at C1 – C2. When somebody does have cervical instability it’s normally because of excessive stretching of the ligaments in the back of the neck. When these ligaments are weak, injured, or torn what happens is the cervical vertebrae move forward when they move forward they can impair the nerve’s impulse through these various nerves. More symptoms such as choking on excretions, spit, or mucus can occur. Difficulty in talking may occur as if your muscles are too weak to talk.

Difficulty swallowing, the inability to breathe properly, and changes in voice are among the most distressing symptoms a person can have. If normal imaging scans and video scopes do not find any obvious structural cause, then, the “ground zero” of cause should suspect and focus on vagus nerve injury and cervical spine instability

This article is a companion work to these articles on our website: Please see

• Vagus nerve compression in the neck: Symptoms and treatments
• Hiccups, Cough, Neck Pain, and Vagus and Phrenic Nerve Injury

In our office, we use injection techniques like Prolotherapy to help stabilize the cervical spine. In many patients, we can reverse these symptoms by stabilizing the cervical spine and restoring the neck’s natural curve.  This is explained below.

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Even though I have neck problems I was sent for an endoscopy – Esophagogastroduodenoscopy

Often we will hear a story, that goes something like this:

I have had chronic problems with my neck. One of my problems is that, over time, I have found it more difficult to swallow foods. I was sent for an endoscopy to rule out digestive problems, I have already had enough X-rays and MRI to rule out cancer. I know the swallowing difficulty is from my neck problems. My diet over the last few months has increasingly become a steady menu of soups and broths. I feel something is stuck in my throat, I belch a lot, and I get anxious about eating for fear of choking on my food. I also find that many times when I try to swallow I feel like I am going to faint or pass out.

My endoscopy was inconclusive

“If she held her head still, she was able to swallow”

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Part 2: Surgery for swallowing difficulties – high risk – low reward? What about the bone spurs?

There is not much research in the medical community that focuses solely on swallowing difficulties in relation to cervical spine instability. But there are many clues that clearly make a connection.

In the April 2017 issue of the Journal of Bodywork and Movement Therapies, a combined team of researchers from the University of Padova and the University of Bologna in Italy documented the case history of a young female patient with swallowing difficulties. (5)

• The patient complained of pain in the neck and swallowing dysfunction that was reduced by means of isometric contraction of cervical muscles. Isometric contraction is a routine exercise where the muscles and joints are held in a static position.
• In other words, the patient was able to find a position where if she held her head still she was able to swallow. If she stabilized her neck, she could swallow.

In this case study, the doctors performed an MRI that revealed an anterior C5-C6 disc protrusion associated with a lesion of the anterior longitudinal ligament. The barium radiograph showed a small anterior cervical osteophyte (bone spur) at the C6 level.

Conclusion: The diagnostic hypothesis was a combination of cervical disc dysfunction associated with C6 osteophyte, reduced functional stability, AND a ligament tear.

• So we have a clue, ligament tears, and cervical neck instability cause swallowing difficulty. If you stabilize the neck, you can swallow.

Searching for clues when surgery and treatment fail to correct swallowing difficulties.

We have seen many patients with degenerative cervical spinal disease who can no longer tolerate continued high dosage narcotic painkillers or the anxiety or depression trip after trip to specialist after specialist is causing them. One clue that we may be able to help these people with their challenges including swallowing difficulties is if you put them in a cervical collar, do they get relief? If the answer is yes, then the collar is providing the missing cervical neck instability.

We do see people with advanced degenerative cervical disc disease who have or had significant bone spur formation. Many of these patients have had surgery to remove the bone spurs, yet their swallowing difficulties remain. If it was not the bone spurs pressing on the esophagus, what could it be? Why do these people still have swallowing difficulties after surgery?

Swallowing difficulties and Diffuse idiopathic skeletal hyperostosis – “an underappreciated phenomenon”

Similarly, Cervicogenic dysphagia can be brought on by diffuse idiopathic skeletal hyperostosis, (DISH) a condition where the cervical ligaments and their attachments to the vertebrae (the entheses)  undergo calcification and ossification. In general terms, the soft tissue has calcified or turned into bone spurs. The bone spurs cause esophageal obstruction. Aging patients, men more so than women are susceptible to swallowing difficulties related to diffuse idiopathic skeletal hyperostosis.

Diffuse idiopathic skeletal hyperostosis is a more common disorder than some doctors thought. Doctors in the Netherlands issued this warning in The Spine Journal:

“Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia and/or airway obstruction may be an increasing and underappreciated phenomenon.”(6)

Diffuse idiopathic skeletal hyperostosis can be brought on by degenerative wear and tear, as mentioned above, as a result of age or overuse. As with any bone spur, bone spurs form to help stabilize a joint. Diffuse idiopathic skeletal hyperostosis develops to stabilize cervical instability by turning the soft tissue attachments that are failing, into bony attachments. This, unfortunately, distorts the cervical spine and leads to various cervical-related symptoms beyond swallowing difficulties.

• Another clue linking the cervical ligaments to swallowing difficulties.

Let’s look at this further:

Diffuse idiopathic skeletal hyperostosis, bone spurs, and cervical spine surgery

An August 2021 study from the University of Iowa Hospitals and Clinics looked at outcomes and complications of surgical treatment of anterior osteophytes (bone spurs at the front of the cervical spine) causing dysphagia to “better understand the functional swallow outcomes, cervical balance, and surgical complications.” The research was published in the journal Clinical Neurology and Neurosurgery. (7)

The researchers wrote that bone spurs from diffuse idiopathic skeletal hyperostosis (DISH) or degenerative disc disease of the cervical spine can cause dysphagia from mechanical compression of the esophagus. “Osteophytectomy is generally accepted as a safe surgical treatment, but the risk of instability is unclear. The potential for associated complications (that is cervical instability) must be considered.”

In this study of 15 surgically treated patients, there was a 27% complication rate including a case of C5 lateral mass fracture with central cord syndrome after a fall four days following osteophytectomy. There was one patient who was preoperatively dependent on a gastrostomy tube required a tracheostomy and had continued reliance on the gastrostomy tube.

The researchers concluded that surgical treatment of anterior osteophytes causing dysphagia with osteophytectomy can lead to overall improvement for most patients, however, a high preoperative (difficulty swallowing) FOSS (Functional outcome swallowing score) score may be a prognostic indicator of poor postoperative functional swallow outcome. The researchers added: “It is important to consider the potential for instability when osteophytectomy is performed at 3 or more spinal segments.”

In April 2024, doctors (8)  in Greece reported on the case of an 85-year-old man with dysphagia. Over the previous two years, the man’s symptoms worsened and became more acute 2 months prior to his office visit. His symptoms included swallowing solid foods and liquids. “Despite prior investigations, including normal gastroscopy and empirical pain management, further assessment revealed bulging masses in the hypopharynx indicative of cervical osteophytes. Conservative management, including speech and swallow therapy, dietary modifications, and pharmacological interventions, resulted in significant symptom improvement without surgical intervention.”

Doctors in Belarus published a 2024 case (9) describing pharyngeal dysphagia and obstructive sleep apnea syndrome caused by degenerative-dystrophic changes in the cervical spine. The case points to large bone spurs at the C3-C6 level. The doctors cited that the bone spurs or osteophytes caused deformation of the posterior wall of the hypopharynx (the back area of the throat that assists in getting food, water, and air down the throat) and narrowing of its lumen. CT scan also showed the intervertebral disc heights lost, as well as osteophytes at the posterolateral margins of the vertebral bodies (disc osteophyte complex causing possible fusion of the vertebrae). Osteosclerosis in combination with facet arthrosis caused spinal and foraminal stenosis. 

Surgery for swallowing difficulties – high risk – low reward? What about the bone spurs?

Using exercise to help swallowing difficulties in cervical instability patients is clearly superior to surgery for patients desiring to avoid surgery. The problems of surgical correction of swallowing difficulties from bony overgrowth (osteophytes or bone spurs) are documented in this research by Turkish surgeons from the Gulhane Military Medical Academy and Gelibolu Military Hospital.

This study was presented in The Journal of Craniofacial Surgery (10) and discusses the advantages and disadvantages of anterior cervical osteophytes surgical procedures. (A frontal incision into the throat area or the mouth to get at the cervical bone spurs).

The doctors looked at the operative records of anterior cervical osteophyte patients who did not benefit from conventional treatments and underwent osteophytectomy (bone spur removal).

Five patients were operated on with the transcervical anterolateral method (incision into the neck), and 3 patients were operated on with the transoral procedure (through the mouth). Those using the transcervical method were likely to encounter complications. Although the transoral procedure is much safer, the patients may face postoperative pain, long healing times, and morbidities such as hematoma, cervical instability, and infection after surgery.

While both surgeries can improve swallowing difficulties, the price of complications and further instability in the future was warned about. The researchers did suggest that the Transoral approach is not recommended due to slow healing times and postoperative pain, although it creates easier access to the spine.

Does surgery cause swallowing difficulties?

In March 2019 in the journal Clinical Neurology and Neurosurgery, (11) researchers at the David Geffen School of Medicine and the Department of Neurosurgery at Kaiser Permanente discussed the reported incidence of dysphagia after Anterior Cervical Discectomy and Fusion. The researchers commented that up to 79% (4 out of 5 surgical patients) will suffer from swallowing difficulties.

Please see our article Anterior Cervical Discectomy and Fusion – The Evidence. Here we discuss the evidence that this surgery can cause more cervical spine instability and deformity

Returning to this study from March 2019, the researchers looked into what caused these problems of swallowing difficulties and further why it appears that doctors are not investigating this problem. The researchers noted:  “There, however, have been no studies that have specifically looked at developing criteria for reducing the incidence of dysphagia for outpatient ACDFs.”

What caused the swallowing difficulties? The researchers found ONLY ONE THING:

• Single-level ACDF at the upper cervical spine (C2-3, C3-4) was found to be the only risk factor for dysphagia with a length of hospital stay of more than 48 hours.
• “These findings should be used for excluding patients who undergo outpatient single-level ACDF surgery to reduce significant postoperative dysphagia.”

An August 2024 (12) study in the Journal of Neurosurgery: Spine, compared rates of dysphagia and patient-reported outcomes following long-segment (more than three levels) anterior cervical spinal fusion (ACF) and posterior cervical spinal fusion (PCF) at 3 and 12 months postoperatively. Patient-reported outcomes were also compared for patients with dysphagia versus those without dysphagia.

• A total of 132 patients met the inclusion criteria, 77 of whom had undergone anterior cervical spinal fusion (ACF) and 55 of whom had undergone posterior cervical spinal fusion (PCF).
  • Similar rates and severity of dysphagia were seen following anterior cervical spinal fusion (ACF) and PCF at three- and 12-month follow-ups. This suggests that long-term dysphagia following cervical fusion surgery may be due to structural changes from the fusion rather than the surgical approach. However, the ACF group was significantly younger, and this may have partially accounted for the findings.
  • Dysphagia may be associated with a decreased quality of life after cervical fusion.

This is an email we received, it has been edited for clarity and continuity. It is not a unique type of email. It is among the many we get describing the similar challenges that many people get.

My primary medical concern is severe dysphagia (swallowing difficulties) which has resulted in a percutaneous endoscopic gastrostomy PEG feeding tube being placed in my stomach. I have been diagnosed with a military Neck (no neck curvature).

Over two years ago I began having difficulty swallowing larger vitamins; however, I was still able to eat and drink without difficulty. More recently I fell and fractured the radial head in my left elbow and hit the side of my head (no concussion). Less than two months later, a cluster of symptoms began which I do not know if they have anything to do with this fall. I had the onset of symptoms- ear ringing/pain, chronic vertigo, chronic nausea- (I had to take Zofran daily for 6+ months) with the onset of severe dysphagia. I was only able to eat a few jars of baby food, protein drinks, and popsicles.

Later, due to the increasing severity of the ear pain, I went to the ER and subsequently was seen by three different ENT specialists. I also was seen at an Urgent Care. All said my ears looked normal. One of the ENTs ordered an MRI of the brain which was normal and I also had a hearing test which came back normal. I was referred to a Gastroenterologist. I had a full GI workup: upper endoscopy, barium swallow, gastric empty study, and modified barium swallow. Two months later I had a modified barium swallow which was abnormal.

Due to the dysphagia and other symptoms, I was referred to a neurologist. I developed the onset of left tongue deviation off and on for months which impacted the dysphagia more. The neurologist ordered lab work and I was negative for myasthenia gravis. A second brain MRI showed a 3 mm cerebellar tonsillar ectopia. (Chiari 1 malformation) I then was referred to a Neurosurgeon.

Due to what the surgeon believed to be Chiari symptoms (chronic pressure in the back of the head, ear ringing, difficulty swallowing, vertigo, blurred vision, tingling in hands in feet, and tongue deviation.) It was decided to do Chiari decompression surgery. My doctor said the surgery would most likely resolve my other symptoms, but due to the severity of dysphagia, he was not sure if surgery would resolve my swallowing difficulties.

I had a Suboccipital craniotomy with C1 laminectomy. Since surgery, the pressure in the back of the head, ear ringing, vertigo, blurred vision, etc. have improved. The swallowing has not. A few months after surgery, my tongue started to deviate to the left again- which it hadn’t for months. I followed up with my neurologist and he does not feel the dysphagia is neurological. I had extensive blood work everything was normal, I had a CT of my neck, I had no curvature in my neck, and have a military neck. I have both Oropharyngeal dysphagia and I feel esophageal dysphagia. When the dysphagia began, I had to order pureed food and was only getting down 400-600 calories a day. The dysphagia has been progressive. After seeing the CT images of my neck- I feel that I have cerviogenic dysphagia. the longer my head is upright, my neck muscles become fatigued which also affects my swallowing. I cannot hold my neck up very long due to severe neck pain.

Many patients had developed compensatory strategies to manage or reduce the burden of these symptoms but lacked professional guidance from health care professionals.

A June 2023 study in the journal BMC musculoskeletal disorders (13) explored coping strategies of patients with dysphagia after anterior cervical spine surgery, “so as to provide the basis for formulating strategies to help patients with dysphagia solve clinical practice problems and to improve their quality of life after surgery.”

• interviews were conducted with 22 participants with dysphagia at 3 time points after anterior cervical spine surgery (7 days, 6 weeks, and 6 months).
• A total of 22 (10 females and 12 males) patients, with years ranging between 33 and 78 years were interviewed.
• The results showed that swallowing-related symptoms may occur after anterior cervical spine surgery. Many patients had developed compensatory strategies to manage or reduce the burden of these symptoms, but lacked professional guidance from health care professionals. . .Healthcare professionals should provide better psychological support in the early or late postoperative period to ensure the improvement of health outcomes and patients’ quality of life.

A January 2024 study in the journal BioMed Central Nursing (14) found orthopedic nurses had moderate knowledge of swallowing disorders after anterior cervical spine surgery and suggested that the knowledge level needs to be improved. In their survey of nurses, the researchers found “orthopaedic nurses have a good understanding of typical symptoms and complications of swallowing disorders, such as “Coughing while eating”, “Feeling food stuck in the throat” and “Aspiration pneumonia”. However, they lack knowledge of implicit aspiration (food going into the lugs). The survey suggested 90.9% of orthopaedic nurses could not recognize the occurrence of silent aspiration, which is consistent with findings in other studies. “Silent aspiration refers to the infiltration of food, liquid, or saliva under the glottis without causing coughing.”

Longer-term Dysphagia after surgery – nerve blocks

A September 2024 case history presented in the journal Anesthesia & Analgesia Practice (15) suggests that dysphagia is reported as a side effect after anterior cervical spine surgery in about 5% to 15% of patients more than one year after surgery. The causes are believed to be “mechanical factors such as pharyngeal thickening and epiglottis inversion. Despite normal neurological examination and electromyography, nerve distortion related to stretching also remains a possibility in these patients and may cause allodynia (heightened or abnormal response to pain) resulting in odynophagia (pain when swallowing) and dysphagia. Current treatment options for dysphagia after anterior cervical discectomy and fusion are limited to local intraoperative steroid injections and tracheal traction exercises. (In this case history), a glossopharyngeal nerve block was effectively used to manage the glossopharyngeal allodynia, thereby reducing odynophagia and dysphagia, and ultimately enhancing oral tolerance (the ability to eat foods).

Part 3: Swallowing difficulties: A problem of autonomic nervous system dysfunction?

Swallowing difficulty may also be due to autonomic nervous system dysfunction that may be caused by Barré-Lieou Syndrome, also known as a posterior cervical sympathetic syndrome and cervicocranial syndrome. This can be a severely debilitating condition in which the autonomic nervous system of the head and neck area is not working correctly. In almost all patients we see, there is a link between cervical spine instability and the onset of Barré-Lieou Syndrome.

Swallowing is a very complex process that involves the mouth, throat, and esophagus. Many nerves and muscles affect the correct functioning of these parts, and while part of the process of swallowing is under voluntary control, much of it is involuntary. Cervical spine instability can affect both voluntary and involuntary responses.

• Another clue linking the cervical ligaments to swallowing difficulties.

Swallowing difficulties: A problem of glossopharyngeal and vagus nerve dysfunction?

Glossopharyngeal and vagus nerve dysfunction are typically the cause of chronic swallowing problems when the person has seen a myriad of clinics without a plausible answer to their symptoms.  The glossopharyngeal innervates the stylopharyngeus muscle which elevates the larynx and pulls it forward during the pharyngeal stage of the swallow. This action also aids in the relaxation and opening of the cricopharyngeus muscles.  It along with the vagus nerve provides the innervation to the upper pharyngeal constrictor muscles.

The glossopharyngeal nerve supplies sensation to the posterior third of the tongue as well as the pharynx down to the level of the larynx (where the vagus nerve begins to take over). The entire palate, including the soft palate, has a sensory distribution from the trigeminal nerve. The glossopharyngeal nerves exit the brain stem side by side and have similar and frequently side-by-side and overlapping functional and anatomical distributions in the periphery. The pharynx is innervated by motor and sensory branches of the glossopharyngeal and vagus nerves. In general, the vagus nerve is motor to the palate elevators and constrictors of the pharynx. Almost all of the muscles that push the food bolus from the pharynx to the esophagus (pharyngeal constrictor muscles) are innervated by the vagus nerve. The vagus nerve is thus involved in the gag reflex. The sensory part of the gag reflex is carried predominantly by the glossopharyngeal nerve and the motor portion by the vagus. When one tests a person’s gag reflex and finds the uvula deviated to one side, it signifies that there is vagus nerve compromise on the opposite side of the deviation

Swallowing difficulties: A problem of neurologic age-related degeneration?

The muscles and support structures of the neck make for good swallowing function. As we age degenerative disease can affect the muscles, tendons, and ligaments that help us swallow.

A 2018 study in the journal Current Opinion in Otolaryngology & Head and Neck Surgery (16) suggests that surgeons and clinicians explore multidisciplinary perspectives and initiatives, (it is not just one thing causing the problem and you may need to explore “innovative” and multiple treatments).

One thing that the researchers suggest as innovative is swallowing exercises. This is to build up the muscular structure of the swallowing mechanism. To build up muscle you need strong tendons and ligaments. You have to deal with the problem of cervical instability.

• Another clue linking the cervical ligaments to swallowing difficulties. It should be clear at this point that there is a link. The next step is how cervical instability affects posture.

A March 2023 study in the American Journal of Speech-Language Pathology (17) from doctors at the Medical University of South Carolina also explored the frequency of swallowing difficulties as it related to advancing age. In this study of 100 people with dysphagia, it was found most patients with dysphagia had spinal pathology. Spinal pathology was judged to be the primary cause of dysphagia in 16.9% of patients with abnormal spine pathology. Of note: “Patients judged to have spine-associated dysphagia tended to have better outcomes than patients with dysphagia from other etiologies, perhaps due to the progressive nature of spinal disease that allows for compensatory swallowing physiology over time.” The body adapted over time to compensate for swallowing difficulties.

A September 2024 study led by the Department of Otolaryngology at the Cleveland Clinic (18) found: “Older adults suffer from increased rates of dysphagia and dysphonia, both of which have a profound effect on quality of life and are often underdiagnosed.” In their survey of 300 patients seeking generalized care with an average age of 76, the researchers found a total of 82 (27.3%) patients screened positive for dysphagia and dysphonia. These positive screening patients took more prescription medications and had a higher GDS or Geriatric Depression Scales score.

Part 4: Swallowing difficulties: A problem of posture?

In the medical journal Dysphagia, (19) researchers discussed the relationship between oropharyngeal (back of the throat) dysphagia and its relationship to cervical spine disorders and postural disturbances due to either congenital or acquired disorders.

They write: “The etiology and diagnosis of dysphagia are analyzed, focusing on cervical spine pathology associated with dysphagia as severe cervical spine disorders and postural disturbances largely have been held accountable for deglutition (swallowing) disorders.”

• Scoliosis,
• kyphosis–lordosis,
• and osteophytes are the primary focus in finding the link between cervical spine disorders and dysphagia.

“It is important for physicians to be knowledgeable about what triggers oropharyngeal dysphagia in cases of the cervical spine and postural disorders. Moreover, the optimum treatment for dysphagia, including the use of therapeutic maneuvers during deglutition, neck exercises, and surgical treatment, (should be discussed with patients).”

In 2017 doctors writing in the journal African Health Sciences (20) examined the effect of different head/neck postures on difficulty while swallowing. In this study, participants were asked to swallow 25 ml of water in one go while sitting upright, sitting with head/neck flexed, head/neck extended and lying supine. Following this, they had to rate their self-perceived difficulty while swallowing on a scale of 0–10, 0 being most easiest and 10 being the most difficult.

According to the participants: it was found to be least difficult to swallow when asked to swallow in upright sitting position. Statistically significant differences were found between sitting upright, sitting with head/neck flexed, head/neck extended, and lying supine. Postural modification may help in the rehabilitation of patients with dysphagia by affecting bolus flow to improve the speed and safety of swallowing by the closure of airways to prevent aspiration.

In August 2023, doctors in Romania published findings on the role of forward head posture in the journal Medicina (21). “Forward head posture is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles.” In other words, and as seen in the image below, the force and pressure being exerted on the neck in the forward head position causes issues with the neck muscles and the neck ligaments.

Returning to the paper, the researchers note: “In forward head posture, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement (moving the larynx and hydroid bone out of the way) during swallowing.” What this study did was assess the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with forward head posture. The researchers believed that without addressing forward head posture, swallowing rehabilitation would not be as successful or would fail the patient. In their study of 61 participants (12-26 years) with forward head posture and atypical swallowing) were divided into two similar groups.

• Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, and group B only had one OMT session per week, for 20 weeks.
• Results: There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR (Global Postural Reeducation) techniques. 

In May 2024, doctors in Brazil published findings (22) on neurogenic dysphagic individuals and the effect of food consistencies on the displacement of the hyoid bone.

The researchers took ultrasound recordings of the oropharyngeal swallowing process in 10 adults diagnosed with oropharyngeal dysphagia and in 10 healthy adults. Results showed dysphagic individuals had lower elevation of the hyoid bone (which can cause food aspiration into the lungs and sleep apnea).

There is a problem with the chewing muscles contributing to problems in your cervical spine and your entire posture

Swallowing difficulties are hard to manage because in some patient cases, possibly yours, you have to continuously “peel the onion,” to get to the true root cause of the patient’s problem. Swallowing difficulties may not be a primary complaint of a patient, but one of the many complaints that seemingly have no answer. Here we are examining whether the muscles of the jaw are negatively impacting your cervical spine and if your swallowing difficulties, indeed many problems you are suffering from, maybe from this connection.

In the European Journal of Orthodontics, (23) doctors in Japan made a connection:

• In this study, the doctors compared the mandibular stress distribution and displacement of the cervical spine. In simple terms, how TMJ instability and hypermobility of the jaw negatively affected the cervical spine.
• What did they find? ” (an) imbalance between the right and left masticatory muscles antagonistically act on the displacement of the cervical spine, i.e. the morphological and functional characteristics in patients with mandibular lateral displacement may play a compensatory role in posture control.”

What? The TMJ altered your posture by stressing your cervical spine. Isn’t posture a problem of swallowing difficulties? Isn’t posture a problem of everything?

Part 5: Swallowing difficulties: TMJ Involvement with cervical instability

In the Journal of Oral and Maxillofacial Surgery: The Official Journal of the American Association of Oral and Maxillofacial Surgeons, (24) doctors looked at oral stage dysphagia (swallowing difficulties that begin in the mouth) with potential effects on function and patient well-being.

To examine the effects of function in TMJ patients, the doctors looked at 178 TMJ/TMD temporomandibular joint dysfunction patients.

• Of the 178 TMD participants, 99% reported at least one symptom or sign of oral-stage dysphagia.
• Individuals presenting with
  • subluxation of the jaw (80%),
  • degenerative joint disorder (67%),
  • and myofascial pain disorder (40%) reported oral-stage dysphagia most frequently.

TMJ tongue’s involvement in swallowing difficulties

An April 2020 study in the Journal of Applied Oral Science (25) assessed tongue function and swallowing in individuals with temporomandibular disorders. They note: “This relationship between tongue function and swallowing is little addressed in individuals with temporomandibular dysfunction (TMD).” Results: Relationships were found between tongue function and swallowing for the following aspects: mobility (the ability of the tongue to move freely), pressure in protrusion (the force that the tongue moves forward during swallowing), swallowing of saliva, mean DDK (the ability to move from one tongue movement to another rapidly) rate in emissions “ta” and “ka” (this is measured by saying “ta” and “ka” as quickly as possible). Thus, the greater the change in tongue mobility (loss of mobility), the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD.” In other words, tongue mobility presented swallowing difficulties in TMJ patients.

There is no doubt that TMJ patients suffer from swallowing difficulties, but do they have cervical instability as well, and is this making swallowing more challenging?

In many patients, we see primary problems related to neck pain and cervical instability see problems of TMJ. In many patients that we see with problems of TMJ, we see cervical neck pain. Surprisingly, despite the research suggesting the connection, many patients were not made aware that their jaw pain could be a problem originating in the neck.

In the medical journal Clinical Oral Investigations, (26) oral surgeons in Belgium made a connection.

They conducted a study looking for possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders.

• Thirty-one consecutive patients with symptoms of TMD and 30 controls underwent a standardized clinical examination of the masticatory system, evaluating the range of motion of the mandible, temporomandibular joint (TMJ) function, and pain of the TMJ and masticatory muscles.
• Afterward, subjects were referred for clinical examination of the cervical spine, evaluating segmental limitations, tender points upon palpation of the muscles, hyperalgesia, and hypermobility.
• The results indicated that segmental limitations (especially at the C0-C3 levels) and tender points (especially in the sternocleidomastoideus and trapezius muscles) are significantly more present in patients with TMJ than in the control subjects.

Part 6: Treating Cervical Spine Instability is treating swallowing difficulties

In this video, DMX imaging displays Prolotherapy results in before and after treatment images. This patient’s treatment had problems of a pinched nerve in the cervical spine resolved. Prolotherapy is discussed below. Prolotherapy is a regenerative medicine injection treatment that utilizes dextrose, a simple sugar as a proliferant to rebuild soft tissue structures.

This video demonstrates the alleviation of cervical disc herniation and the patient’s related symptoms.

• In this video, we are using a Digital Motion X-ray (DMX) to illustrate a complete resolution of a pinched nerve in the neck and the accompanying symptoms of cervical radiculopathy.
• A before digital motion x-ray at 0:11
• At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
• At 0:34 DMX three months later after this patient had received two Prolotherapy treatments
• At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure on the nerve
• At 1:00 another DMX two months later and after this patient received four Prolotherapy treatments
• At 1:14 the previously completely closed neural foramina are now opening normally during motion

Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments

Now let’s explore a March 2019 study in the medical journal Spine. (27) This research comes from the Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan. the goal of this study was to investigate whether cervical (neck) alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis.

This is what the researchers found puzzling:

• Diffuse idiopathic skeletal hyperostosis involves a wide range of ligamentous ossifications (calcifying of the ligament), which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.

So they looked at 5 patients with advanced dysphagia due to anterior cervical hyperostosis (bone spurs) who underwent bone removal, and five patients with mild symptoms who were only monitored.

• The Eating Assessment Tool-10 (EAT-10) (most of you are aware this is a swallowing evaluation measurement) indicated a high degree of dysphagia in the people who had surgery for bone removal compared with the non-surgical group.
• In the surgery group, the EAT-10 score significantly decreased postoperatively and improvement in dysphagia was observed.
• The conclusion was: “Restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.”

What is this research telling us?

• Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments
• Weakened cervical neck ligaments cause neck instability
• Neck instability causes abnormal motion in the cervical vertebrae
• Abnormal motion causes bone spurs
• Bone spurs cause swallowing difficulties.

Conservative care treatments and other symptoms and conditions

We will see many patients who were told about surgeries, such as those spoken above, and offered surgical consultation for his/her problem with swallowing if there is a concern the problem is due to a diverticulum or outpouching of the throat. However, the surgical recommendation is often compromised by the difficulty in diagnosis and concurrent diagnoses.

Conservative treatments may be offered to see if the surgery is warranted or, better yet, avoided.

Recommendations to relieve the symptoms may include:

• a bland diet,
• hydration,
• eliminating caffeine or alcohol from the diet,
• modifying the consistency of foods to make them easier to swallow,
• elevating the head while sleeping, or
• therapy to strengthen the swallowing muscles, particularly when the swallowing difficulty seems to be the result of a neurological disorder.
• In certain situations, drugs that slow the production of stomach acid, muscle relaxants, or antacids may be prescribed.

Exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet

A June 2024 study in the journal Medicina (28) looked at oropharyngeal dysphagia (patients cannot form a bolus of food to move it from the mouth to the esophagus.) Many patients with oropharyngeal dysphagia are at risk of depression while quality of life deteriorates.

In this study: “Patients with oropharyngeal dysphagia received complex treatment: exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet.” The quality of life of 64 patients was assessed. The results show that the quality of life improved after the complex treatment of oropharyngeal dysphagia.

• The average age of patients was 77.8 years, and 56.3% of patients were women.
• At baseline, mild oropharyngeal dysphagia was found in 18.8% of patients; moderate in 51.6%; and severe in 29.7%.
• Aspiration risk was low in 28.1% of patients; medium in 39.1%; and high in 32.8%.
• The severity of oropharyngeal dysphagia and aspiration risk significantly decreased after treatment.

An April 2024 paper (29) presented the case of a 78-year-old patient with sarcopenic dysphagia (swallowing-related muscle degeneration) that improved swallowing function after strength training of swallowing-related muscles using neuromuscular electrical stimulation. This 78-year-old man had an intraductal papillary mucinous tumor of the pancreatic duct. After admission for treatment, the patient developed aspiration pneumonia and was placed on strict bed rest without oral intake, which resulted in progressive malnutrition. After 86 days of treatment, the doctors concluded: “As a component of swallowing rehabilitation, neuromuscular electrical stimulation may offer therapeutic benefits for patients with sarcopenic dysphagia.”

Hydration

A July 2024 study (30)  from Spanish researchers discussed the importance of hydration in people with dysphagia and its consequences. They write: “Dysphagia increases the risk of malnutrition and dehydration in the patient. However, dehydration, although one of the most common complications of dysphagia and associated with significant risks, including hospitalization and mortality, has been little studied in terms of its relationship and associated risk factors.”

In this review of previously published research, the authors continued: “Dehydration is a frequent and serious complication in patients with dysphagia, which can lead to problems such as urinary tract infections, constipation, confusion, and worsening of chronic diseases. Therefore, it is crucial to carefully evaluate and monitor the fluid intake of these patients, and strategies to improve hydration include the use of thickened liquids, stimulating appetite, and adapting the texture and presentation of foods . . . adequate assessment and management of hydration, is essential to prevent serious complications.”

However, the truth is, a person suffering from this often painful and debilitating condition may be seen by numerous specialists and yet find no resolution for the symptoms and, thus, no understanding as to why the condition exists at all.

In our office, we perform a physical examination and use our ultrasound and Digital Motion X-ray machine, described in the video above to get at the cause of the problem rather than simply seek to treat the symptoms. This helps us determine, if, as often, we are looking at a dysfunction of the autonomic nervous system, a problem of posture, a problem of degenerative aging, or a problem possibly of TMJ-related challenges.

Swallowing difficulties as well as a host of other symptoms including neck, eye, and facial pain, cervical vertigo, dizziness, and ringing in the ears, is very treatable using Prolotherapy to the neck ligaments.

Prolotherapy is, in our opinion, the safest and most effective non-surgical treatment for repairing ligament damage. It stimulates the body to repair damaged and weakened areas by inducing a mild inflammatory reaction. Since the body heals from inflammation, Prolotherapy stimulates healing.

As mentioned earlier, swallowing difficulty may also be due to an autonomic nervous system dysfunction. While the actual cause of this dysfunction may be elusive, Neural Therapy to the head and neck area has been known to help with swallowing difficulties. Neural therapy involves the injections of anesthetics to help the nerves reset themselves. For example, if the patient had previously had surgery in the mouth or neck area, the scars would be injected as they can act as “interference fields” to the autonomic nervous system.

Brain fog, breathing and swallowing difficulty, dizziness, tinnitus

Brad’s story will resonate with many of you. He will describe the same symptoms and combination of symptoms that many of our patients suffer with when they first see us.

Brad’s story is unique, it may not be typical of the patients we see. Brad with treated with Prolotherapy injections and neck curve correction techniques. Not everyone will achieve these results as the results of treatment will vary.

We specifically want to highlight his case because he has some unusual strange sensations in his ear and breathing difficulties because of his problem with his contracting diaphragm.

Patient symptom list:

• Ringing in the ears and a sensation in his ears of hot wax. He also reported it was as if spiders were crawling in his ears.
• Severe dizziness. The patient describes that he would be in a car and then out of nowhere he would get dizzy and it would feel like the car was flipping end over end.
• Brain fog
• Contracting diaphragm
  • Patient’s description at 1:32: “I would just be sitting or standing there, doesn’t matter which, and all of a sudden I couldn’t breathe. Finally, I would take a big gasp of air, and finally, I would be able to breathe.
• Swallowing difficulties: The saliva in his mouth would build up and it was as if he was drowning. This would cause panic attacks.
• The patient also reported when he turned his head to the right, he would lose control of all his muscles and would “drop.”

The patient had these symptoms for 3 – 4 months. It started with a fall of a ladder. Symptoms did not develop for months

• The patient fell off a ladder from a height of 12 feet. He hit a sink and his head snapped backed
• His symptoms started to develop four months after the fall

Because of the nature of his injury and ligament damage in his cervical spine, the patient underwent eight prolotherapy treatment sessions. Here is his description:

• After the eight sessions, the patient reports “almost everything is gone.” A slight ringing in the ears remains but is diminishing.
• The patient did not realize how bad his brain fog was. On his first visit, he had difficulty filling out paperwork. On his last visit he realized filling out the paperwork was “super easy.” It was then he realized the extent of his brain fog.
• The diaphragm problems went away after the 4th or 5th visit along with the swallowing difficulties.

The problems of people with fibromyalgia and dysphagia

A February 2024 study from Trinity College Dublin published in the journal Health Expectations (31) looked at eight patients with fibromyalgia to try to learn more about the lived experiences of dysphagia among people with fibromyalgia. A topic, barely covered in the medical research.

• All eight participants reported the negative psychosocial impact of their dysphagia. Participants reported managing their dysphagia by themselves
• Participants discussed feeling unsupported in healthcare interactions due to clinicians not understanding the occurrence, nature, or impact of eating, drinking, and swallowing difficulties.
• Participants also reported that they did not have access to evidence-based management strategies that adequately addressed their fibromyalgia-related swallowing problems. The researchers suggested: “Perhaps as a consequence of the negative experiences with health professionals . . . many participants here reported self‐managing their dysphagia.

The same researchers also published in the medical journal Dysphagia (32)  that “People with fibromyalgia can experience both autonomic and somatic disturbances, cognitive and mental health symptoms, and hypersensitivity to external stimuli. Fibromyalgia often co-occurs with a range of well-researched comorbidities (e.g., temporomandibular disorders, migraine, and irritable bowel syndrome). However, emerging research suggests that individuals with fibromyalgia also often experience eating, drinking, and swallowing problems (e.g., odynophagia, glossodynia, etc.). However, there is very little known about these issues, their psychosocial impact, or the best means of managing them clinically.” In this review study, researchers found that dysphagia and GERD are prevalent in fibromyalgia patients (51.9% and 25.9%, respectively), among other issues. From reviewing existing literature, eating and swallowing problems appear to be common among adults with fibromyalgia.

Research on cervical instability and Prolotherapy

Caring Medical has published dozens of papers on Prolotherapy injections as a treatment for difficult-to-treat musculoskeletal disorders. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problems of swallowing difficulties or cervicogenic dysphagia.

In our own research, our Caring Medical research team published a comprehensive review of the problems related to weakened damaged cervical neck ligaments. (33)

This is what we wrote: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems is not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs (such as swallowing difficulties) or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”

What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and in the case of cervicogenic dysphagia-type symptoms, cervical instability.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

At the Hauser Neck Center in Fort Myers, Florida a common complaint that I hear almost every day from new patients that come in is that they have a choking sensation and they have episodes of panic because it’s difficult to breathe.

A patient told me after they suffered a car accident “I would feel like I was choking and I couldn’t breathe I always felt that there was secretions in my throat and that we were going down into my lungs. I couldn’t breathe, it felt like my airways were getting blocked.”

We see many patients suffering from many symptoms. One of the symptoms is the choking sensation. We find that many of these people have cervical instability and this can lead to the following problems of:

• slurred speech
• personality changes
• insomnia
• always feeling fatigued
• lightheadedness
• light sensitivity
• ear pain
• ear pressure
• various kinds of headaches
• head pressure
• anxiety
• autonomic storms
• cognitive decline

The question then can be asked, “Is my choking sensation something related to my neck? Possibly if you are someone with a clicking, popping, grinding in your neck. For someone who has neck pain, or someone who has been on the computer for years, the answer can be yes.

In the image taken from the video, if you are constantly looking down, there is a change in the neck curve. When the curve changes, the vagus nerve gets stretched. When the vagus nerve is stretched it goes into dysfunction. This may cause you to NOT swallow properly, or the food goes into your lungs, not down to your stomach. The epiglottis, which is the flap that prevents food from going into the lungs, is innervated by the vagus nerve. If the vagus nerve is damaged or dysfunctional, the epiglottis will be dysfunctional. In addition, the swallowing muscles can be impacted leading to choking or difficulty breathing.

We hope you found this article informative and that it helped answer many of the questions you may have surrounding Cervical disc disease and difficulty swallowing. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit our contact page!

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carotid sheath