Why is water coming out of my nose when I swallow?

Dec 16, 2022

A side effect and swallowing dysfunction in which liquid comes out of the nose is called velopharyngeal insufficiency. This may occur following treatment of cancer to the oropharyngeal region.  The levator veli palatini is responsible for elevating the soft palate to seal the nasal passageway from the pharynx while swallowing. An incomplete seal of these muscle groups will result in nasal regurgitation of liquids.

Patients may be referred to a speech language pathologist who can aide in the evaluation and management of this side effect. There is no cure or fix to the muscle groups. However, there are compensatory strategies that can improve the management of liquids coming out of the nose. A speech pathologist may opt to send their patient for a swallowing study called a modified barium swallow study in which the visualization of the liquid flowing back can be observed and different treatment options may be trialed during the test. One downside to this type of test: the muscle groups are not visualized.

 How can I decrease the water coming out of the nose?
Every patient is different depending on the treatment of where the cancer was located. However certain strategies may work consistently.

  1. Take smaller sips from the edge of the cup.
  2. Do not tilt your head backwards when you drink from the cup, keep the head neutral.
  3. Trial a nosey cup. 
  4. Turning the head to the left or the right may help when you swallow.
  5. Ask the speech pathologist if you are a candidate for expiratory muscle strength trainer (EMST150 or EMST75)

There are no known effective exercises that fix velopharyngeal insufficiency. As a last resort some patients may opt to discuss with their ENT if they are candidate for a palatal obturator in which a device is built specific for the patient like a denture plate that is worn during meals and closes off this space when worn. Velopharyngeal insufficiency does not disappear and here is for lifelong management.