Help me please, oropharyngeal dysphagia since 2020 that gets better after sleep, worse as the day goes on, and changes with neck position. I also have a persistent neck lymph node and a history of toxoplasmosis. Has anyone experienced anything similar?
Hi everyone. I’m a 31-year-old man, and I’ve been dealing with swallowing problems since March 2020.
It started pretty suddenly.
Ever since then, the problem has felt mostly oropharyngeal. It doesn’t usually feel like food gets stuck lower down in my chest. It’s more like the swallowing motion itself sometimes doesn’t happen normally, almost like my throat or larynx isn’t completing the movement properly.
The strangest part is how much it changes throughout the day.
When I wake up in the morning, my swallowing is usually much better. Breakfast is almost always the easiest meal.
As the day goes on, swallowing gradually gets harder. Lunch can be more difficult, and dinner is usually the worst.
But here’s the really weird part:
If I take a nap before eating, my swallowing often gets noticeably better again after I wake up.
Sometimes even 30–60 minutes of sleep or rest makes a real difference.
It almost feels like sleep somehow “resets” my swallowing for a while.
Neck position also makes a big difference.
When I bend my neck forward and bring my chin toward my chest, I feel much more pressure under my jaw and around my throat.
If I extend my neck, I usually feel like there’s more room and swallowing can feel easier.
When I flex my neck a lot, the tissue under my jaw bunches up quite a bit, almost like a double chin, even though I’m not obese. I have no idea whether that actually matters internally, but it’s one of the reasons I’ve started wondering more about structural causes and the soft tissues of the neck.
I also have some breathing-related symptoms.
When I lie down or start falling asleep, I sometimes feel like my throat is narrowing or like I can’t get enough air. Sometimes I wake up suddenly feeling like I’m choking or gasping.
I’ve also been diagnosed with obstructive sleep apnea.
That makes me wonder whether the breathing problems and swallowing problems could somehow be connected through the upper airway, although nobody has actually proven that in my case.
There’s another part of the story that has always bothered me.
Since around the time all of this started, I’ve had a small palpable lymph node/lump in my neck, and it’s still there.
I also have a history of toxoplasmosis and cervical lymphadenopathy.
I’m not saying toxoplasmosis is causing my dysphagia. It could be completely unrelated. But I still think it’s worth mentioning because the lymph node appeared around the same general time and never completely went away.
While searching the medical literature, I found a case report that really caught my attention.
It involved a 66-year-old immunocompetent woman who developed a foreign-body sensation and difficulty swallowing solids along with a persistent left cervical lymph node. Her barium swallow didn’t show any structural abnormality, and flexible laryngoscopy was also normal.
The lymph node was around 1.4 cm and stayed there for months. It was eventually biopsied, and the findings were compatible with Toxoplasma gondii lymphadenitis.
Obviously, that doesn’t mean I have the same thing. I just found it interesting because it involved dysphagia, a persistent cervical lymph node, and toxoplasmosis, with some of the initial tests also being normal.
I also have a pretty long uvula, and depending on my position it can get very close to or touch my tongue.
Other symptoms I’ve had include:
- pressure/fullness under my jaw and in the submental area
- a constant foreign-body sensation in my throat
- thick saliva or mucus
- frequent throat clearing
- a feeling that my larynx or hyoid doesn’t move upward normally when I swallow
- swallowing getting worse later in the day
- breathing discomfort that changes depending on position and sleep
- frequent burping, sometimes even after just a small sip of water
The burping has actually become much more noticeable lately.
Sometimes I can take just one small sip of water and immediately need to burp, even if I haven’t eaten much and haven’t had anything carbonated.
What’s strange is that lately, when the burping starts, I also begin to feel worse in my neck. I get that same pressure/fullness under my jaw and in the submandibular area, almost like something is tightening or building up there.
I don’t know if the burping is actually causing the neck/throat sensation or if they’re both being triggered by the same underlying problem, but I’ve noticed the connection enough times that it seems worth mentioning.
I’ve wondered about reflux, air swallowing, supragastric belching, or some kind of upper esophageal/throat issue, but none of that has been specifically confirmed.
Over the years I’ve had several tests and evaluations, including:
- flexible laryngoscopy
- upper endoscopy
- videofluoroscopic swallow study / modified barium swallow
- neck imaging
- ENT evaluations
- speech/swallow evaluations
My endoscopy also showed a small hiatal hernia and gastritis, and LPR/silent reflux has been considered as a possible explanation.
One problem is that some of these tests were done when I was feeling relatively okay.
For example, my swallowing can be much better in the morning than it is later in the afternoon or at night, so I keep wondering whether a test done in the morning might miss what happens when my symptoms are actually bad.
I’m attaching part of my swallow study video too.
I also have a neck MRI scheduled soon.
One of the things I want them to look at is the deeper soft-tissue anatomy, including the base of the tongue, floor of the mouth, sublingual and submandibular areas, parapharyngeal spaces, oropharynx, hypopharynx, and the area around the hyoid and larynx.
Recently I’ve been reading papers about fat inside the tongue and around the pharynx.
There are studies showing that fat accumulation inside the tongue can be associated with a larger tongue, changes in hyoid position, and abnormal upper-airway anatomy.
I’m definitely not saying this is what I have, but I’m curious about it because my symptoms are so dependent on neck position and I also have sleep apnea.
After more than six years, these are still the things I can’t explain:
- Why can I swallow so much better after sleeping?
- Why does my swallowing gradually get worse as the day goes on?
- Why can a nap sometimes improve it again?
- Why does bending my neck forward make the pressure and swallowing feel worse, while extending it seems to help?
- Could my sleep-related breathing problems and dysphagia somehow be connected?
- Could the persistent cervical lymph node be completely unrelated, or has anyone here had swallowing problems connected to cervical lymph nodes or inflammation?
- Has anyone had frequent burping or air coming back up together with throat or submandibular pressure?
I’d especially like to hear from anyone whose dysphagia:
- changes a lot depending on the time of day
- improves after sleeping or resting
- gets worse with neck flexion
- comes with breathing problems during sleep
- started around the same time as a neck lump or lymph node
If you’ve had anything remotely similar, what did you eventually get diagnosed with?
And what test finally found the problem?
MRI? FEES? Modified barium swallow? High-resolution pharyngeal manometry? DISE? Neurological testing?
Most importantly, what actually helped you?
I’m not expecting Reddit to diagnose me. I’ve just been dealing with this for years, and I’m trying to find people with a similar pattern or ideas about things that might be worth discussing with my doctors.
Sorry for the long post. I just hope sharing my case can help other people who are also living with dysphagia and trying to figure out what’s going on.