Dear Doctor: Why do the elderly often have a hard time swallowing, and sometimes experience a feeling that food is stuck in their throats? I heard there’s a procedure to stretch the throat. Does it help?

Dear Reader: The condition you’re asking about is known as dysphagia, which refers to difficulty in swallowing. Patients may have trouble starting a swallow, or problems with the esophagus, which is the muscular tube that connects the throat with the stomach.

The origins of the disorder fall into several basic categories. There are neurological causes, such as stroke, Parkinson’s disease, multiple sclerosis, dementia and head injury. Certain muscular conditions can affect the proper functioning of the esophagus. So does obstruction, which can result from a narrowing of the esophagus, or from inflammation. These can be caused by head and neck cancers, radiation therapy, tuberculosis and chronic acid reflux.

Although dysphagia can affect people of all ages, you’re correct that it’s seen more often in older adults. This is commonly due to age-related changes in the body, such as loss of muscle tone, mass and strength, and changes to nerve function. Still, dysphagia is not considered to be a normal sign of aging.

Understanding dysphagia starts with the mechanics of swallowing. We tend to think of it as the “gulp” that empties the mouth. But that’s just the first step of a complex process. A successful swallow moves the contents of your mouth through the throat, and all the way down to the stomach. This happens when a ring of muscles known as the upper esophageal sphincter and located at the lower end of the throat, open. Next, coordinated contractions along the length of the esophagus send the food to a second ring of muscles known as the lower esophageal sphincter. This leads to the stomach. At the same time, muscles and specialized structures within the throat prevent anything from getting into the nose, voice box and windpipe.

Symptoms of dysphagia can include pain while swallowing, struggling or being unable to swallow, feeling as though food is stuck in the esophagus, coughing or gagging when trying to swallow, regurgitation or frequent heartburn. Some people may experience drooling or develop a hoarse voice. Diagnosis of the condition includes a physical exam and any of a variety of tests that may include X-rays, muscle tests and swallowing studies.

Treatment depends on the specific cause of the condition. Patients may be asked to change their diet, use certain exercises and techniques that help with swallowing coordination, or manage acid reflux with medication.

The procedure you asked about, known as esophageal dilation, is useful when dysphagia results from a narrowing of the esophagus. It involves the use of an endoscope and either plastic dilators or a special balloon to slowly and gradually stretch the esophagus. Complications, which are rare, include bleeding and tears or holes in the esophagus. In most cases, the patient is able to resume normal eating and drinking the following day.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I have Morton's neuroma in both feet, and my podiatrist has recommended surgery. I really don’t want to have surgery, so I am desperately looking for another remedy. I read about a drug that was being fast-tracked by the FDA. Has it been approved yet?

Dear Reader: Morton’s neuroma is basically a pinched nerve in the ball of the foot, most often between the third and fourth toes. The nerve, which carries sensation from the toes, becomes swollen due to a benign growth. This allows the nerve to rub against, bump into or become trapped by the bones and connective tissues of the mid-foot. This results in sensations ranging from numbness, burning and tingling in the forefoot, the toes or both, all the way to outright -- and sometimes significant -- pain. Some people also experience swelling between the toes.

The cause for Morton’s neuroma isn’t fully understood. However, contributing factors include narrow shoes, which squeeze the toes; high-heeled shoes, which exponentially increase the pressure exerted on the ball of the foot; and damage to the nerve due to trauma, inflammation and illness. Biomechanical issues such as flat feet or high arches, which can lead to instability around the joints of the toes, are believed to play a role. Bunions or hammer toes are also considered to be risk factors for developing Morton’s neuroma. The repeated stress associated with high-impact sports, such as running and basketball, can also give rise to a neuroma.

Some neuromas can be diagnosed with a physical exam to locate tenderness in the ball of the foot, or to identify a mass. Some people report a sensation of clicking between their toes. Imaging tests such as ultrasound can isolate tissue abnormalities associated with a neuroma. Although an X-ray won’t diagnose the condition, it can rule out other potential causes, such as a stress fracture.

Treatment depends on the severity of the condition. Many people find relief with a change of footwear. Flat-soled shoes with a roomy toe box and adequate padding beneath the ball of the foot can relieve pressure and protect the affected area. Custom shoe inserts, known as orthotics, can also offer relief. Some people require anti-inflammatory medications or cortisone injections to manage pain and inflammation. In severe cases, an outpatient surgery to remove the inflamed and enlarged nerve may be necessary.

The drug you’re asking about, known as CNTX-4975, is being developed to address moderate and severe knee pain associated with osteoarthritis. It’s an intriguing approach to pain management, which uses a laboratory-derived version of a substance called capsaicin, one of the compounds that give chili peppers their heat. The idea is that when delivered via an injection, the capsaicin will interfere with the neurological process that transmits pain signals to the brain.

You’re correct that at one point, the drug was being considered for use in Morton’s neuroma. However, the company developing the drug has decided to focus its use for knee pain due to osteoarthritis. Clinical trials of the drug are ongoing.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Our dad’s left eye and the side of his face started to droop suddenly, and it seemed like he’d had a stroke. The doctor says it’s actually Bell’s palsy. What is that?

Dear Reader: We can imagine the concern -- and subsequent relief -- when the signs that suggested your father had suffered a stroke turned out to be Bell’s palsy. Although the two are quite different, there is some crossover in symptoms. Add in the fact that, unlike stroke, Bell’s palsy isn’t that well-known, and it’s easy to understand the confusion.

Bell’s palsy is a type of temporary facial paralysis that arises from damage to the facial nerve. For fellow science nerds, this is the seventh cranial nerve, which animates the muscles we use to make facial expressions like smiling, raising our eyebrows, frowning and winking. It’s also involved in the sense of taste, the functioning of the salivary and tear glands, and the muscles of a small bone in the middle ear.

Although the exact cause for Bell’s palsy isn’t known, it occurs when something causes the nerve to become swollen, inflamed or compressed. Illness, injury and a family history of the disorder may also play a role.

As happened with your dad, the symptoms of Bell’s palsy can appear quite suddenly. In other cases, the paralysis may take a few days to develop. The onset of facial drooping, which usually occurs on only one side of the face, can indeed seem like the effects of a stroke. So can the ensuing weakness, numbness or twitching. Other possible symptoms of Bell’s palsy include headache, mild fever, ringing in the ears, pain behind the ear or near the jaw of the affected side, drooling and changes to taste and hearing. Once the symptoms begin, there is no known way to stop them.

About 40,000 people in the United States develop Bell’s palsy each year. It affects men and women at equal rates, and it is most common between ages 15 and 60. People living with diabetes and those recovering from a respiratory ailment such as a cold or the flu appear to be at greater risk. With no diagnostic tests currently available, Bell’s palsy is identified via a physical exam and the process of elimination. The symptoms are localized and specific, though, so it’s not a difficult diagnosis.

Mild cases don’t require treatment and begin to resolve on their own, often within two or three weeks of the onset of symptoms. In most people, facial nerve function returns to normal within three to six months.

It’s possible -- but quite rare -- for the symptoms to become permanent. Also possible but rare are recurrences of the disorder. In more serious cases, steroids such as prednisone can be effective in reducing inflammation and swelling. If infection is present, it will also be addressed. Since the facial paralysis can affect the eyelid and tear ducts, it’s important to take steps to protect the affected eye from debris, and to keep it lubricated.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)