Aerodigestive Disorders - Types, Symptoms, and Treatment

Introduction:

The aerodigestive tract comprises both the respiratory tract and a part of the digestive tract. It includes the pharynx, larynx, and esophagus. Hence, breathing and swallowing mechanisms occur in the aerodigestive tract. Both mechanisms function in a coordinated biomechanical sequence. This helps in protecting the airway during mastication and allows sufficient airflow during speech.

What Are the Different Types of Aerodigestive Disorders?

Patients with swallowing disorders and complex breathing experience aerodigestive disorders. The different types of aerodigestive disorders include:

Upper Respiratory Tract Disorders:

• Congenital craniofacial disorders result in feeding and breathing difficulties.

• The laryngeal cleft interrupts phonation.

• The laryngeal web causes the narrowing of the respiratory tract.

• Laryngeal stenosis compromises the airway.

• A congenital defect in larynx tissue causes laryngomalacia.

• Nerve damage to the vocal cord eventually leads to vocal cord paralysis.

Esophageal Disorders:

• A rare disorder that affects the food pipe is called achalasia.

• Exposure to corrosive or hazardous substances results in caustic ingestion.

• Colonic interposition results in the removal of a part of the colon and reconnecting it with the esophagus.

• Eosinophilic esophagitis causes inflammation of the esophagus.

• Esophageal diverticula are the projections of tissue between the airway and the esophagus.

• Esophageal duplication has an additional spherical muscular structure.

• Improper movement of the esophagus during digestion is due to esophageal dysmotility disorders.

• Esophageal strictures occur due to the unusual strain in the esophagus.

• An extension of the esophageal tissue results in esophageal webs.

• Gastroesophageal reflux disease causes a backflow of acids into the mouth.

• An abnormal opening in the aerodigestive tract is called a tracheoesophageal fistula.

Lung Disorders:

• Cartilage disorders in the lungs cause bronchomalacia.

• Severe lung illness causes aspiration of interstitial fluid inside the lungs.

What Are the Causes of Aerodigestive Disorders?

• Defect in the origin and development of the aerodigestive tract causes congenital aerodigestive disorders.

• Injury to the aerodigestive tract during an approach to the lungs, pharynx, or larynx.

• Dysfunction of the lower esophageal tract due to weakness.

• Constant anxiety or emotional stress causes increased muscle tension.

• Laryngeal hyperreactivity due to environmental irritants.

• Diabetic neuropathy affects the nerves of the pharynx and larynx.

• Neurological disease with autonomic dysfunction affects the aerodigestive tract.

• Cystic fibrosis or chronic lung disease causes incoordination of aerodigestive mechanisms.

• Cancer in the neck and stomach results in the narrowing of the aerodigestive tract.

What Are the Different Signs and Symptoms Seen in Aerodigestive Disorders?

The signs and symptoms are as follows:

1. Children affected by aerodigestive disorders show disinterest in eating.

2. Choking occurs immediately after eating.

3. The patient always has a feeling of something is stuck inside the food pipe.

4. The patient takes much time to swallow the food and complete the meal.

5. The patient takes an effort to swallow and has pain while swallowing.

6. Aerodigestive disorders cause the regurgitation of food.

7. The patient has an increased urge to clear the throat.

8. Unintentional weight loss is commonly present.

9. Wet breathing sounds are heard during inspiration and expiration.

10. The patient is unable to speak with a flow called aphonia.

11. The patient has pain during increased phonation.

12. The patient exhibits strain during phonation.

13. Inflammation of the vocal cords changes the voice pitch.

14. Chronic cough with marked mucus secretion. In adults, it lasts for two to three months. In children, it lasts for more than a month.

15. The patient takes an increased effort to breathe and requires mechanical ventilation.

16. Rapid respiratory rate.

17. Wheezing is present.

18. Irritants trigger the vocal cord and cause transient voice loss.

19. Patients experience tightness in the chest.

20. Persistent asthmatic attacks are seen.

How Are Aerodigestive Disorders Diagnosed Using Various Diagnostic Methods?

An effective treatment plan can be achieved after an accurate diagnosis. A few diagnostic methods for aerodigestive disorders include the following:

• Chest X-Ray - It is the initial diagnostic tool used to diagnose aerodigestive disorders at a minimal cost. However, it has limited use and can only be used to evaluate the narrowing of the aerodigestive tract.

• Fiberoptic Endoscopic Evaluation of Swallowing (FEES) - A thin instrument is inserted into the pharynx to reach the esophagus. It is attached to a camera. The camera takes pictures of the pharynx and esophagus. Medical professionals use FEES to evaluate the motility of the esophagus and swallowing reflex.

• Airway Fluoroscopy - X-rays are continuously taken targeting the airways. This helps the medical professional to obtain a motion picture. It is used to guide interventional surgical procedures. It is performed under general anesthesia and usually has less discomfort. It provides images of high quality with minimal radiation exposure.

• CT (Computerized Tomography) Scan - The X-rays are taken at different angles, and the obtained images are interpreted in a monitor to evaluate the digestive tract, pharynx, esophagus, and trachea. It is also used to observe congenital aerodigestive disorders in young children. The blood vessels and nerves are clearly depicted using the CT scan. Abdominal neoplasm, inflammation in the pharynx, and injury to the pharynx can be observed using a CT scan.

What Are the Treatment Procedures Available to Treat Aerodigestive Disorders?

• Vocal Cord Medialization - The affected vocal cord is deviated to the other side to normalize the patient’s functions like phonation and swallowing. The paralyzed vocal cord is reinnervated using a nerve from the ansa cervicalis (motor nerve present in the neck). It is attached to the recurrent laryngeal nerve. It improves muscle tone, phonation, and swallowing in young children and adults.

• Gastrostomy Tube Placement - A gastric tube is placed inside the stomach to aid in the delivery of nutrients. It helps to overcome swallowing difficulties. Since, it is directly placed in the stomach, there is less chance of aspiration and gagging reflux. However, there is a slight discomfort for the patient.

Conclusion:

Patients affected by aerodigestive disorders require additional support from life therapists and speech pathologists. Life therapists help to cope with the anxiety that occurs due to phonation. The speech pathologist helps to improve speech and language skills. Feeding and swallowing disorders are treated by the gastroenterologist. Oncologists and surgeons help in treating the esophageal neoplasm. Therefore, a multidisciplinary approach is necessary for treating patients with aerodigestive disorders. The prognosis is better, and the recurrence rate is low in patients affected by aerodigestive disorders.