Throat and Voice

Disorders that affect our ability to speak and swallow properly can have a tremendous impact on our lives and livelihoods. ENT specialists treat sore throat, infections, gastroesophageal reflux disease (GERD), throat tumors, airway and vocal cord disorders, and more.

Dysphagia means that you can’t swallow well. Dysphagia is not a diagnosis; it is the symptom. Many factors may cause dysphagia, and most are temporary and non-life-threatening.

In uncommon situations, swallowing difficulties can be related to a tumor or a nerve system disorder. It happens to people of all ages, but more often in the elderly. If swallowing is difficult on a regular basis, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist.

People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces. The process of swallowing has four related stages:

  1. The first stage is the oral preparation stage, where food or liquid is made ready in the mouth, chewed, and gathered together in preparation for swallowing.
  2. The second stage is the oral stage, where the tongue pushes the food or liquid to the back of the mouth, starting the swallowing response.
  3. The third stage is the pharyngeal stage, when what is processed in the mouth is passed through the pharynx, your throat, and into the esophagus, your food pipe.
  4. In the fourth and final stage, the esophageal stage, food or liquid passes through the esophagus and into your stomach.

The third and fourth parts of the swallowing process happen automatically, without you even thinking about it.

What Are the Symptoms of Dysphagia?

Symptoms of swallowing disorders may include:

  • Drooling
  • A feeling that food, liquid, or pills are sticking in the throat
  • Coughing or choking on bits of food or liquid, or saliva not moving easily, which may lead to aspiration (when these materials fall or get sucked into the lungs)
  • Sensing of a “lump” in the throat
  • Losing weight
  • Developing lung infections like pneumonia
  • Changing voice
  • Coughing up blood

What Causes Dysphagia

Dysphagia may result from one or more of these issues

  • Acid reflux
  • Throat infections (such as tonsillitis)
  • Age-related swallowing muscle weakness
  • Food or other foreign body becoming stuck in the throat (particularly in older patients)
  • Weakness or scar of the esophagus
  • Vocal fold paralysis or weakness
  • Side effect of medications
  • Tumors (throat, lung, esophageal cancer)
  • Prolonged illness needing long stays at the hospital
  • Past surgery or radiation to the neck, back, or chest
  • Nerve disease such as Parkinson’s disease, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease), Myasthenia Gravis, or stroke

What Are the Treatment Options?

Your ENT specialist may work with other healthcare specialists, such as a gastroenterologist (GI), neurologist, and/or speech-language pathologist (SLP), to accurately diagnose and effectively treat the source of the problem.

When dysphagia is frequent, and the cause is not clear, your ENT specialist will discuss the history of your problem and examine your mouth and throat. They may insert a small tube called a flexible laryngoscope through your nose to help them examine your throat in greater detail. Sometimes, giving you food or liquid while the scope is in place helps them get a better look at the back of your tongue, throat, and voice box (larynx), and see what happens when you swallow. This procedure is called flexible endoscopic evaluation of swallowing (FEES).

Your doctor and/or specialist may also order other tests like the barium swallow (or esophagram) and modified barium swallow. In these tests, instead of a flexible laryngoscope, X-rays record how food and drinks go down, and help your doctor evaluate the entire swallowing process. If necessary, they may refer you to a GI doctor for an upper endoscopy, which evaluates the esophagus and stomach with a flexible camera. Additional testing can include pressure testing (manometry), which evaluates pressure created by the throat and esophagus muscles to see if they are working correctly.

If you have trouble swallowing, it is important to seek treatment to help you avoid malnutrition, dehydration, and pneumonia.

Acid reflux occurs when acidic stomach contents flow back into the esophagus, the swallowing tube that leads from the back of the throat to the stomach. The esophagus has ways of protecting itself against small amounts of acid reflux, so you might not feel the acid every time a little bit flows up into the esophagus. When there is a lot of acid, a person feels “heartburn” and we would call this “typical” acid reflux. The medical term for this is “Gastro-Esophageal Reflux” or GERD”.

However, the upper part of the esophagus and the voice box area do not have the same way of protecting against small amounts of acid. So even a small amount of acid, which does not always cause heartburn, can irritate the throat area. We often call this “throat burn” or “atypical reflux”, but the medical name is “Laryngo-Pharyngeal Reflux” or “LPR”.

While GERD and LPR can occur together, people sometimes have symptoms from GERD or LPR alone. Having symptoms twice a week or more means that GERD or LPR may be a problem that could be helped by seeing a doctor.

What Are the Symptoms of GERD and LPR?

Many patients with LPR do not experience classic symptoms of heartburn related to GERD. And sometimes, adult patients may experience symptoms related to either GERD or LPR like:

  • Heartburn
  • Belching
  • Regurgitation (a surge or rush back) of stomach contents
  • Frequent throat clearing or coughing
  • Excess mucus
  • A bitter taste
  • A sensation of burning or throat soreness
  • Something “stuck” or a “lump” in the back of the throat
  • Hoarseness or change in voice
  • Difficulty swallowing
  • Drainage down the back of the nose (post-nasal drip)
  • Choking episodes (can sometimes awaken from sleep)
  • Difficulty breathing, if the voice box is affected

Signs in infants and children are different from adults and may include:

  • Breathing problems such as a cough, hoarseness, noisy breathing, or asthma
  • Pauses in breathing (apnea) or snoring when sleeping
  • Feeding difficulty (spitting up)
  • Turning blue (cyanosis)
  • Choking
  • Apparent life-threatening event where there is arching of the back while in distress
  • Trouble gaining weight or growing

What Causes GERD and LPR?

GERD and LPR can result from physical causes and/or lifestyle factors. Physical causes can include weak or abnormal muscles at the lower end of the esophagus where it meets the stomach, normally acting as a barrier for stomach contents re-entering the esophagus. Other physical causes include hiatal hernia, abnormal esophageal spasms, and slow stomach emptying. Changes like pregnancy and choices we all make daily can cause reflux as well. These choices include eating foods like chocolate, citrus, fatty foods, spicy foods or habits like overeating, eating late, lying down right after eating, and alcohol/tobacco use (see below).

GERD and LPR in infants and children may be related to causes mentioned above, or to growth and development issues.

What Are the Treatment Options?

Your primary care provider or pediatrician will often refer you to an ENT (ear, nose, and throat) specialist, or otolaryngologist, for evaluation, diagnosis, and treatment if you are having related symptoms.

GERD and LPR are usually suspected based on symptoms, and can be further evaluated with tests such as an endoscopic examination (a tube with a camera inserted through the nose), biopsy, special X-ray exams, a 24-hour test that checks the flow and acidity of liquid from your stomach into your esophagus, esophageal motility testing (manometry) that measures muscle contractions in your esophagus when you swallow, and emptying of the stomach studies. Some of these tests can be performed in an office. Please see our link regarding the Restech 24 hour nasopharyngeal pH probe that we offer at Northside ENT.

Options for treatment include lifestyle and dietary modifications (see below), medications, and rarely surgery. Medications that can be prescribed include antacids, ulcer medications, proton pump inhibitors, and foam barrier medications. To be effective, these medications are usually prescribed for at least one month, and may be tapered off later after symptoms are controlled. For some patients, it can take two to three months of taking medication(s) to see effects.

Children and adults who do not improve with medical treatment may require surgical intervention. Surgical treatment includes “fundoplication,” a procedure that tightens the lower esophageal muscle gateway (lower esophageal sphincter, or LES). Newer techniques allow this to be done in an endoscopic or minimally invasive manner. Another surgical option uses magnetic beads to tighten the LES.

What Changes Can I Make to Prevent GERD and LPR?

For adults, you can take certain steps to reduce or prevent occurrences of GERD and LPR, including:

  • Lose weight.
  • Cut down or stop smoking tobacco products.
  • Limit or avoid alcohol.
  • Wear clothing that is looser around the waist.
  • Eat three to four small meals a day, instead of two to three large ones, and eat slowly.
  • Avoid eating and drinking within two to three hours of bedtime.
  • Limit problem foods, such as caffeine, carbonated drinks, chocolate, peppermint, tomatoes, citrus fruits, fatty and fried foods, and/or spicy foods.

Hoarseness (also called dysphonia) is an abnormal change in the quality of your voice, making it sound raspy, strained, breathy, weak, higher or lower in pitch, inconsistent, or fatigued, often making it harder to talk.

This usually happens when there is a problem in the vocal cords (or folds) of your voice box (larynx) that produce sound. Your vocal cords are separated when you breathe, but when you make sound, they come together and vibrate as air leaves your lungs. Anything that alters the vibration or closure of the vocal cords results in hoarseness.

What Are the Symptoms of Hoarseness?

If you have any of these symptoms for hoarseness, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, as soon as you can:

  • Hoarseness that lasts more than four weeks, especially if you smoke
  • Severe changes in voice lasting more than a few days
  • Voice changes, such as raspy, strained, breathy, weak, higher or lower in pitch, inconsistent, fatigued, or shaky voice
  • Difficult breathing
  • Pain when speaking
  • Vocal professionals (singer, teacher, public speaker) who cannot do their job

What Causes Hoarseness?

Acute laryngitis—The most common cause of hoarseness is acute laryngitis. A cold, viral infection in your breathing tract, or voice strain can make your vocal cords swell. You can seriously damage your vocal cords if you talk while you have laryngitis.

Non-cancerous vocal cord lesions—Nodules, polyps, and cysts usually develop after prolonged trauma to the vocal cords from talking too much, too loudly, or with bad technique.

Pre-cancerous or cancerous lesions—Pre-cancer or cancerous lesions on the vocal cords can also cause hoarseness. If it lasts four weeks or more, or if you are at a higher risk of developing throat cancer (i.e., you smoke), you should have your voice box evaluated by an ENT specialist.

Neurological diseases or disorders—Hoarseness can occur with Parkinson’s disease or after a stroke. A rare disorder called spasmodic dysphonia can also create hoarseness or uneasy breathing. A paralyzed vocal cord, usually after surgery, viral illness, or injury, may also cause a weak, breathy voice.

Vocal cord atrophy—As we age, our vocal cords become thinner (decreased bulk) and floppy (decreased tone). This is not due to talking too much or too little, it’s just a fact of life. A raspy voice that changes from day to day with decreased power is common.

Vocal cord hemorrhage—You can lose your voice after yelling or other strenuous vocal activity if a blood vessel/blood blister breaks, filling the vocal cord with blood. This is a vocal emergency and should be treated with complete voice rest and examination by an ENT specialist.

Are There Related Factors or Conditions?

Reflux—Reflux is when acidic or non-acidic stomach contents move from the stomach up into your swallowing tube (the esophagus). Classic heartburn and indigestion are symptoms of gastroesophageal reflux (GERD), which is caused by acid. If the stomach acid travels up the esophagus and spills into the throat or voice box (called the pharynx/larynx), it is known as laryngopharyngeal reflux (LPR).

Smoking—Most importantly, smoking increases the risk of developing throat cancer. Smoking can also cause permanent changes to your vocal cords that can lead to swelling, which lowers the pitch of your voice and can block the airway in severe cases. Smokers who develop hoarseness should see an ENT specialist right away.

Other—Other related factors such as allergies, thyroid problems, trauma to the voice box, and, occasionally, menstruation can contribute to hoarseness.

What Are the Treatment Options?

An ENT specialist needs to obtain your medical history and look at the voice box (larynx) with special equipment before they can determine what’s causing your hoarseness and recommend treatment options. They may pass a very small, lighted flexible tube with a camera (called a fiberoptic scope) through your nose to view your vocal cords. Most patients tolerate these procedures well. Sometimes, it helps to measure voice irregularities, how the voice sounds, airflow, and other characteristics to help decide how to treat your hoarseness.

Appropriate treatment depends on the cause of your hoarseness.

Acute laryngitis—Supportive care and voice rest are usually the recommended courses of action for acute laryngitis. Antibiotics and steroids are often not needed, and your primary care physician can manage this. If your hoarseness lasts beyond typical cold symptoms, however, you should see an ENT specialist.
Non-cancerous vocal cord lesions—Treatment for non-cancerous vocal cord lesions includes learning proper voicing technique with voice therapy, adequate hydration, and sometimes surgery.

Pre-cancerous or cancerous lesions—Surgery is needed to diagnose and treat pre-cancerous or cancerous lesions. Sometimes, other cancer treatments are needed, such as radiation therapy or chemotherapy.

Neurological diseases or disorders—Determining why your vocal cords are paralyzed helps your doctor decide the best course of action. Sometimes, vocal cord augmentation is needed. For patients with Parkinson’s disease, special voice techniques can help, but evaluation is also very important. Mumbled speech (called dysarthria) after a stroke or from a degenerative neurologic disorder can be addressed with speech therapy or the use of assistive communicative devices. Other disorders can be treated with botulinum toxin, or Botox®, injections.

Vocal cord atrophy—Treatment for vocal cord atrophy includes voice therapy and, sometimes, vocal cord injection, but reassurance from your doctor that your hoarseness is not due to cancer may be all that you need for peace of mind.

Vocal cord hemorrhage—Treatment usually includes resting your voice and avoiding blood thinners. Surgery is rarely needed.

Are There Potential Dangers or Complications?

Depending on the cause of your hoarseness, long-term concerns range from permanent hoarseness, inability to effectively communicate with others, loss of work for vocal professionals, to major surgery or, in severe cases, death from cancer and cancer-related treatments. That’s why it’s very important to see an ENT specialist to be evaluated for persistent hoarseness.

General vocal wellness tips include:

  • Avoid speaking in loud environments.
  • Be aware of how much and how loudly you are talking.
  • Use a microphone or other type of voice amplification if your job requires a lot of talking (like teaching or public speaking).
  • Drink plenty of water, usually around 60 ounces daily. This helps thin out mucus.
  • Avoid large amounts of caffeine, such as caffeinated coffee, tea, and soda.
  • Stop smoking and avoid secondhand smoke. This is a good idea for all smoked products.

Tonsils are the two round lumps in the back of your throat. Adenoids are high in the throat behind the nose and the roof of the mouth (referred to as your soft palate). They are not visible through the mouth or nose without special instruments. Adenoids usually atrophy (shrink) as kids get older and are usually no longer visible by early adulthood.

Tonsils and adenoids are part of the immune system and help protect the body from disease. They “sample” bacteria and viruses that enter through the mouth or nose. Unfortunately, sometimes they can get infected or cause problems by being too large.

What Are the Symptoms of Tonsil and Adenoid Difficulty?

Tonsillitis is an infection of the tonsils. Symptoms may include:

  • Swelling of the tonsils
  • Redder than normal tonsils
  • A white or yellow coating on the tonsils
  • A slight change in the voice due to swelling
  • Sore throat sometimes accompanied by ear pain
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

If your or your child’s tonsils or adenoids are enlarged, it may be hard to breathe through the nose, or cause difficulty while sleeping. Other signs of adenoid and/or tonsil enlargement include:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds “blocked” when the person speaks
  • Chronic runny nose
  • Noisy breathing during the day
  • Recurrent ear infections
  • Snoring at night
  • Restlessness during sleep, or pauses in breathing for a few seconds at night (this may indicate sleep apnea, or other sleeping disorder)

You should see your ENT (ear, nose, and throat) specialist, or otolaryngologist, when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.

Vocal cord paralysis and paresis can result from abnormal function of the nerves that control your voice box muscles (laryngeal muscles).

People have one set of two vocal cords, also known as vocal folds, that work together in your voice box to produce sound. They open when you breathe in to let the air flow through your lungs, and they close and vibrate when you speak (this is called phonation).To produce adequate voice, both vocal cords should move toward each other and close completely to vibrate together (this is called glottic closure).

Your vocal cords move through the contraction of various muscles controlled by your brain and a specific set of nerves. Vocal cord paralysis and paresis can result from abnormal function of the nerves that control your voice box muscles (laryngeal muscles). Paralysis is a complete absence of vocal cord movement, caused by a complete loss of nerve input; paresis is a weakened vocal cord movement, caused by a partial loss of nerve input. There are two nerves that can be involved:

  • The recurrent laryngeal nerve (RLN) carries signals to different voice box muscles responsible for opening, closing, and adjusting tension in the vocal cords. Healthy function of this nerve is needed for breathing, speaking, coughing, and swallowing.
  • The RLN goes into the chest cavity and curves back into the neck until it reaches your voice box. Because the nerve is relatively long and takes a “detour” to the voice box, it can be damaged or compressed by tumors in the neck or chest, or injured after surgery to the neck or chest.
  • The superior laryngeal nerve (SLN) carries signals to a small muscle (called the cricothyroid) that controls your pitch. This muscle adjusts the tension of the vocal cord for high notes during singing (like a guitar string). An injury or damage to the SLN can cause inability to increase pitch when singing or reach higher notes.

Depending on your needs, vocal cord paralysis can cause great difficulty, or only mild problems. For instance, if you’re a professional singer, even mild paresis might end your career; if you’re a computer programmer, however, you might see little ill effect.

What Are the Symptoms of Vocal Cord Paralysis?

Symptoms of paralysis and paresis of the vocal cords can include:

  • Voice changes—Hoarseness, breathy voice, weak voice, gurgling quality to the voice, shortness of breath after speaking
  • Airway problems—Shortness of breath with efforts, noisy breathing, unsuccessful cough
  • Swallowing problems—Choking or coughing when swallowing food, drink, or saliva, and food sticking in throat

These symptoms can be mild to severe depending on the degree of paralysis, and the ability of your voice box to adapt. Depending on the cause, your symptoms may resolve with time or persist.

What Causes Vocal Cord Paralysis?

Vocal cord paralysis can happen at any age and come from different causes, including:

  • Idiopathic—An idiopathic vocal cord paralysis means that no specific cause could be found despite diagnostic tests. This happens in up to 50 percent of cases. One theory is that the common cold virus may cause nerve inflammation.
  • Unplanned injury during surgery—Surgery in the neck (thyroid gland, carotid artery, cervical spine) or in the chest (lungs, esophagus, heart, or large blood vessels) may cause RLN or SLN paresis or paralysis.
  • Breathing tube/intubation—Though rare, injury to the RLN may occur when breathing tubes are inserted to assist breathing for an extended period of time (in the intensive care unit, for example).
  • Tumors of the skull base, neck, and chest—Tumors (both cancerous and non-cancerous) can grow around nerves and squeeze them, resulting in varying degrees of paresis or paralysis.
  • Viral infections—Inflammation from infections may injure a brain nerve (called the vagus) or its nerve branches to the voice box (RLN and SLN). Illnesses affecting nerves in the whole body may also affect the voice box nerves.
  • Auto-immune diseases—Various auto-immune diseases can cause transient or permanent vocal cord paralysis.
  • Neurological causes—Strokes and other neurological diseases can cause vocal cord paralysis.

How is Vocal Cord Paralysis Diagnosed?

If you suffer from symptoms of vocal cord paralysis, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, who may diagnose your condition from one or more of these methods:

  • Flexible laryngoscopy—After asking questions about your symptoms, an examination of your voice box will be carried out, using a small, flexible camera that goes through your nose and down your throat to examine the voice box. If this exam reveals vocal cord paralysis or paresis, further tests can be ordered to determine the cause of the paralysis.
  • CT scan—A CT scan of the head, neck, and/or chest can be ordered to make sure there is no mass or lesion compressing the nerve along its course in the body.
  • Blood work—Blood tests can be ordered to test for auto-immune diseases.
  • Laryngeal electromyography (LEMG)—A LEMG test measures electrical currents in the voice box muscles that are the result of nerve signals. Your doctor may have you perform certain tasks to test these muscles, then look at the pattern of electrical currents to see whether the nerve signals show signs of recovery or repair, and to determine the degree of the nerve problem.

What Are the Treatment Options?

Depending on the severity of your vocal cord paralysis and how much it affects your everyday life, your ENT specialist can offer different treatments options, including:

Voice therapy—Like physical therapy for an injured knee, voice therapy can help improve vocal function before having to consider surgery.

Surgery—The decision to have surgery depends on the degree of the symptoms, voice needs, position of the problem vocal cord, the outlook for recovery, and the cause of the problem, if known. There are two main types of surgical procedures to treat vocal cord paralysis:

  • Vocal cord injection—A filling material is injected into the vocal cord to close the gap between your vocal cords. This can be done while you are awake (sometimes in your doctor’s office or in the operating room) or while you are asleep in an operating room. The duration of results will vary depending on the material injected.
  • Laryngeal framework surgery (also called medialization laryngoplasty)—Your surgeon will make a small incision in your neck and insert an implant into your voice box to move your vocal cord toward the middle, helping both cords close and vibrate better. Commonly used implants include silastic blocks (silastic is a form of silicone gel) or Gore-Tex sheets. This procedure is often done under local anesthesia in the operating room, and the results are typically permanent.

If you suffer from vocal cord paralysis, your doctor will be able to guide you and find the best treatment options for your symptoms and needs.

Cancer of the voice box, or laryngeal cancer, is not as well known by the general public as some other types of cancer, yet it is not a rare disease.

The American Cancer Society estimates that there will be about 13,150 new cases of laryngeal cancer (10,490 new cases in men and 2,660 new cases in women), and about 3,710 deaths from laryngeal cancer (2,970 men and 740 women).1 Even for survivors, the consequences of laryngeal cancer can be devastating with respect to voice, breathing, or swallowing. It is a preventable disease, however, since the primary risk factors for laryngeal cancer are associated with changeable behaviors in lifestyle.

What Are the Symptoms of Laryngeal Cancer?

Signs and symptoms of laryngeal cancer include:

  • Worsening or persistent hoarseness
  • Difficulty swallowing
  • Persistent sore throat or pain with swallowing
  • Difficulty breathing
  • Pain in the ear
  • Lump in the neck
  • Coughing up blood

Anyone with these signs or symptoms should be evaluated by an ENT (ear, nose, and throat) specialist, or otolaryngologist. This is particularly important for people with risk factors for laryngeal cancer.

What Are the Causes and Risk Factors Associated with Laryngeal Cancer?

Many factors can lead to the development of laryngeal cancer, including certain viruses such as human papilloma virus (HPV), but approximately 90 percent of head and neck cancers occur after exposure to known cancer-causing substances, called carcinogens. Chief among these factors is tobacco. Over 90 percent of laryngeal cancers are a type of cancer called squamous cell carcinoma (SCCA), and over 95 percent of patients with laryngeal SCCA are smokers. Smoking contributes to cancer development by causing mutations or changes in genes, preventing carcinogens from being cleared from the respiratory tract, and decreasing the body’s immune response.

Tobacco use is measured in pack-years. For example, two pack-years is defined as either one pack per day for two years, or two packs per day for one year (longer terms of pack-years are determined using a similar ratio). Depending upon the number of pack-years smoked, studies have reported that smokers are about five to 35 times more likely to develop laryngeal cancer than non-smokers. The longer you are exposed to tobacco is probably more important to developing cancer than the intensity of the exposure.

Alcohol is another important risk factor for laryngeal cancer because it promotes the cancer-causing process, especially in the presence of tobacco. People who smoke and drink alcohol have a combined risk that is greater than the sum of the individual risks. Other risk factors for laryngeal cancer include HPV and acid reflux.

What Are the Treatment Options?

The best “treatment” is prevention: laryngeal cancer is a preventable disease in most cases, because the main risk factors are associated with lifestyle behaviors that can be modified or changed. The American Cancer Society recommends that those who drink alcoholic beverages should limit the amount of alcohol they consume—one drink per day is considered limited exposure to alcohol. It also recommends avoiding tobacco in any form. Vitamin A and beta-carotene may play a protective role in helping to decrease the risk of developing laryngeal cancer.

That said, the primary treatment options for laryngeal cancer include surgery, radiation therapy, chemotherapy, or a combination of these treatments, the first two being the most commonly recommended treatments. However, these treatments take a toll on the body.

Potential Complications of Non-treatment

You and your doctor can discuss the best treatment option(s), but potential complications of not treating your condition include:

  • Persistent sore throat
  • Complete loss of voice
  • Disfigurement in the neck area
  • Bloody cough or bleeding from the mouth
  • Complete inability to swallow or aspiration of food and liquid into lungs leading to pneumonia
  • Difficulty breathing or even complete airway blockage, possibly requiring a tracheostomy (a special tube through the neck into the trachea or windpipe to bypass the blocked airway)

A Zenker’s diverticulum (ZD) is a rare condition where an “outpouching” occurs where your throat meets your esophagus, the swallowing pipe that leads into your stomach.

When this happens, a pouch forms and mucus, food, and/or liquid can become stuck instead of going down your esophagus and into your stomach like normal.

What Are the Symptoms of ZD?

If you have a ZD, you may experience:

  • Difficulty swallowing
  • Regurgitating or vomiting undigested food hours after eating
  • Inhaling food or saliva down your windpipe (called aspiration)
  • Belching
  • Noisy swallowing
  • Bad breath
  • Choking
  • Coughing
  • Hoarseness
  • Feeling like something is stuck in the back of your throat
  • Weight loss
  • Recurrent lung infections in severe cases

What Are the Treatment Options?

If you have any of the symptoms mentioned here, you should be examined by an ENT (ear, nose, and throat) specialist, or otolaryngologist. Your ENT specialist may diagnose your condition using a “barium swallow” study. This is a special type of X-ray test that helps your doctor take a closer look at the back of your mouth, throat, and esophagus to see how you swallow food and liquid.

There are no current medications to treat ZD, so the usual treatment is surgery unless your ZD is small and doesn’t cause too much difficulty or discomfort. If your doctor recommends surgery, however, there are several options including making an incision on the neck, as opposed to a less-invasive approach through the mouth.

For open surgery, a small incision is made in the neck and the pouch is either removed or tacked upside down so that it doesn’t collect food. During this procedure the muscle below the ZD, your cricopharyngeus muscle, is cut to prevent recurrence of the ZD. Most patients stay in the hospital for a few days after surgery to recover from this procedure.

During an endoscopy or approach through the mouth to make repairs, there are no incisions on the outside of the neck. With this approach, a stapling device is used to divide the wall between the esophagus and the ZD to make a common cavity for food and liquid to flow directly into the esophagus without becoming stuck. Your doctor can discuss the pros and cons of each procedure and help you choose the best option for you.

Following surgery, you may notice:

  • A sore throat
  • Pain in your ears
  • Pain at your incision site
  • Pain in your jaw joints

You should call your ENT specialist if you experience any of these post-surgical symptoms:

  • If you have a hard time breathing (go to ER or call 911)
  • If you have signs of a wound infection (fever, redness, swelling, tenderness, pus-like drainage)
  • If you have chest, upper back, or neck pain
  • If you cough up or vomit more than a few tablespoons of blood
  • If you have a fever over 101 degrees Fahrenheit

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