Nasal regurgitation, the unexpected flow of food or liquid into the nasal cavity during or after swallowing, can be an unsettling experience. This article clarifies what nasal regurgitation is and when it warrants attention.
Understanding Nasal Regurgitation
Nasal regurgitation occurs when swallowed substances, such as food or fluids, enter the nasal passages instead of moving down the esophagus. This happens because the nasopharynx, the upper part of the throat connected to the nasal cavity, does not close completely during swallowing.
The soft palate, a fleshy part at the back of the roof of the mouth, along with the uvula, is a key component. During normal swallowing, the soft palate elevates and seals off the nasopharynx. This prevents food or liquid from entering the nasal cavity, directing it into the pharynx and then the esophagus.
When It’s Expected Versus Concerning
Nasal regurgitation can be an occasional, benign occurrence, often triggered by actions like laughing, sneezing, or breathing heavily while swallowing. In these instances, food or liquid briefly enters the nasal cavity without lasting consequences.
In infants, occasional nasal regurgitation, particularly of milk, is normal. Their swallowing reflexes are still maturing, and their smaller esophageal capacity, liquid-only diet, and prolonged time spent lying down can contribute to this. This usually resolves as they grow older.
However, frequent or persistent nasal regurgitation, especially in older children and adults, often indicates an underlying issue. If it happens routinely, it may be a symptom of a swallowing disorder, medically known as dysphagia. Consistent nasal regurgitation can suggest a problem with the muscles or nerves involved in the swallowing process.
Common Underlying Causes
When nasal regurgitation is not an occasional event, it often points to medical or physiological issues affecting the swallowing mechanism. One cause is velopharyngeal sphincter dysfunction (VPD), where the soft palate and surrounding throat structures fail to create a proper seal between the nasal and oral cavities. This can be due to structural abnormalities or problems with muscle coordination.
Structural issues like a cleft palate, an opening in the roof of the mouth, prevent the nasopharynx from closing. This condition, present from birth, allows liquids to pass into the nasal cavity during feeding. Enlarged tonsils can also obstruct the soft palate’s ability to seal off the oral from the nasal cavity.
Neurological conditions affecting the nerves and muscles involved in swallowing are another cause. Conditions such as stroke, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), cerebral palsy, and muscular dystrophy can impair the coordination and strength of muscles required for proper swallowing. This impairment, known as neurogenic dysphagia, can lead to food or fluid entering the nasal passages.
When to Seek Medical Advice
If nasal regurgitation becomes frequent or is accompanied by other concerning symptoms, seeking medical advice is important. Specific red flags include difficulty swallowing (dysphagia), painful swallowing (odynophagia), or coughing and choking during or after eating or drinking. Other symptoms that warrant medical attention are hoarseness, a persistent sore throat, shortness of breath, chest pain, or unexplained weight loss. In infants, signs like excessive crying or arching the back during feeding, or a wet, gurgly voice after feeding, suggest a need for professional assessment. A healthcare professional will take a thorough medical history and may recommend imaging tests to observe the swallowing process and determine the underlying cause.