Food coming out of my nose


#1

Is this a symptom to do with swallowing?

I felt something funny happening as I ate a sandwich for lunch today, I felt the need to blow my nose and some lettuce came out.

It’s not the first time it’s happened, a few weeks ago I was eating fried rice and a whole lot somehow went up my nose. Water has gone down the wrong way a few times too.

Thanks


#2

I would suggest you visit your GP with a view to being referred to an ENT specialist.
If food were to get into your lungs, you could get into big trouble with aspiration pneumonia.


#3

Yep. The swallowing difficulty is called dysphagia and when food starts coming out your nose, it’s called nasal regurgitation. Lovely. I remember the odd pea coming out that way. I still get drinks coming out my nose. If there is a speech therapist attached to your movement disorder clinic they will usually monitor your swallow & can be helpful with suggestions like the chin-tuck posture (ie head forward).

Back in Dec. 2002, about 6 months after my gp gave me a couple of antidepressants I noted that food was starting to fall out of my mouth. Then the movement disorder consultant gave me Sulpiride and it got worse. I started dribbling.

By May 2003 I was choking occasionally and by August noted :” I try to avoid talking while eating – a tricky task when at table with 4 offspring as the food that hangs about on the back of my tongue has a tendency to go down the wrong way.”

I was also losing weight - a stone that year .

In Nov. 2003 I noted “eating hard work, just sits in my mouth have to chew then suck the bits down - and get all tense.”

Jan. 04 Speech therapist observes “spasms leading to constriction in the larynx and increased tension in the muscles throughout the pharyngeal area, including the soft palate. Speech was intelligible but very effortful and tiring. Swallowing was similarly interrupted by the dystonia leading to drooling and a difficulty with bolus formation with occasional choking when most severe.”

By Feb. 2004 I had gone down another stone to nearly 9 stone. Pretty skinny for me. (5’6”)

2010 Speech therapist reports “She had some difficulty controlling the food in her mouth and forming a bolus, but was able to swallow it safely without signs of airway penetration. The manipulation of food in her mouth is hampered by her reduced dentition with broken teeth”

She didn’t use the word ‘dysphagia” till 2014:

“Coughing was reported when eating and drinking. [She] reported that she has had dietetic advice and has managed to put on weight by eating high calorie soft foods such as quiche microwaved to make the pastry soft. She prepares smoothies and milk shakes.The 150mls timed water swallow test was completed in 60 seconds with 7 swallows from a cup. {She}supported her right hand, which held the cup, with her left hand. This helped to control the shaking.

There was spillage due to her involuntary movements and she reported she prefers to lean over and sip fluids via a straw from a glass left on the table

A pot of yoghourt was eaten slowly, but safely with no signs of airway penetration. Oral bolus control in the mouth was difficult due to the involuntary movements. This is exacerbated by sore mouth and reduced dentition. Soft, moist, forkmashed or blended foods are therefore the safest choice. No chest infections were reported

[She] presented with a moderate-severe hyperkinetic dysarthria resulting from a loss of bulbar muscle control due to involuntary movements. She had an accompanying oropharyngeal dysphagia managed successfully at present through texture modification .”

https://pmj.bmj.com/content/77/913/694

Management of neurogenic dysphagia Bakheit AMO Postgraduate Medical Journal 2001; 77: 694-699.

The oral phase is initiated voluntarily and serves to prepare the food bolus and deliver it to the pharynx. An adequately prepared and sufficiently large and cohesive food bolus triggers the swallow reflex by stimulating the sensory receptive field in the soft palate, dorsum of the tongue, epiglottis, and posterior pharyngeal wall.

Simultaneously the larynx closes and the velum retracts upwards to prevent the entry of food and fluid into the nasal cavity.

…Nasal regurgitation of fluids occurs when palatal weakness is present.

Drooling, which is commonly seen in patients with parkinsonism, is not due to excessive salivation but is an indication of bradykinesia of the oropharyngeal musculature.

Article below has useful drawings: https://www.aafp.org/afp/2000/0415/p2453.html

Evaluation and Treatment of Swallowing Impairments J. B. PALMER, J. C. DRENNAN, and M. BABA, Am Fam Physician. 2000 Apr 15;61(8):2453-2462.