What Can Difficulty Swallowing and Voice Fatigue Mean? (Ep 152)

This episode explains why difficulty swallowing (dysphagia) and voice fatigue/dysphonia are common yet underrecognized in people with POTS, hypermobile EDS, and MCAS. Mechanisms include autonomic neuropathy causing esophageal dysmotility and poor upper esophageal sphincter coordination; connective‑tissue laxity in EDS promoting reflux/laryngopharyngeal reflux (LPR), hiatal hernia, and vocal fold insufficiency; and mast‑cell–mediated edema, irritation, and mucus that worsen throat tightness, cough, and inducible laryngeal obstruction (VCD/ILO). Related contributors include sicca/dryness, deconditioning/respiratory pattern dysfunction, cervical instability or vagal irritation, and small fiber neuropathy. Red flags needing urgent evaluation: weight loss, food impaction, choking/aspiration, recurrent pneumonia, blood, progressive neurologic deficits. Recommended workup may involve ENT exam with flexible laryngoscopy/stroboscopy, speech‑language pathology assessment, FEES or videofluoroscopic swallow study, esophageal manometry, and pH‑impedance testing; consider MCAS and reflux assessment. Management blends lifestyle and therapy first: hydration, humidification, reflux‑reduction (small meals, avoid late eating/acidic‑spicy‑fatty foods, elevate head of bed, alginate), voice therapy and gentle vocal hygiene, breathing retraining for ILO, targeted swallow therapy/compensatory strategies, and posture/neck stabilization as appropriate. Pharmacologic options are individualized: short courses of PPIs or H2 blockers for reflux/LPR; mast‑cell stabilization (H1/H2 blockers, cromolyn, leukotriene antagonists) when MCAS is active; saline/xylitol sprays and saliva substitutes for dryness; and, in select cases, prokinetics (e.g., prucalopride, low‑dose erythromycin) or botulinum toxin for cricopharyngeal spasm. The episode emphasizes coordinated care between ENT, SLP, GI, allergy/immunology, and dysautonomia‑savvy clinicians to improve safety, comfort, and voice endurance.