Hyperactive Gag Reflex

Hyperactive Gag Reflex: Definition, Description, Causes and Risk Factors:

Hyperactive gag reflex is the body’s response to the stimulation of soft palate or posterior pharynx. Every one has a gag, but it becomes a problem when an individual finds it difficult to eat certain foods or perform certain activity. It is a very common feeding disorder among children. If your baby throws up and chokes herself every time you try to feed her with certain foods, it could be due to hyperactive gag reflex. Children with this disorder simply refuse to take solid foods or foods with a particular texture. This makes it impossible to feed them.

Before getting to gag reflex causes, let us first get to the mechanism behind this awful feeling of throwing up whenever you stick something in your mouth that goes far towards the back of your throat and touches the soft palate. The irritation caused to the pharynx by such an activity always, without fail, evokes a disgusting feeling as if you’re going to throw up. There are different levels of sensitivity among different people with regards to causes and extent of gag reflex. Gagging is a natural phenomenon which is meant to prevent anything, which is not part of the natural eating and swallowing process, from entering the throat in order to keep the person from choking by obstruction of the respiratory tract, the upper part of which is connected to the upper part of the digestive tract. However, sometimes gagging is artificially induced by sticking one’s finger inside the mouth, far down the throat, to orally expel food that was recently eaten. This method is widely used by bulimics, victims of a kind of eating disorder, who frequently induce vomiting this way soon after eating something.

Whenever something that is not part of the natural swallowing process enters the throat so far as to touch the soft palate, the back of the throat contracts and we get a feeling that we are about to vomit. The glossopharyngeal nerve fibers, which pass from behind the nasal cavity, pick up the sensation whenever an unnaturally large amount of food is swallowed or something other than food is attempted to be pushed down the throat. These nerve fibers transmit the gag sensations to the solitary tract and spinal trigeminal nuclei. Finally, these signals reach the brain which sends back instructions, in the form of electric pulses and chemical signals, back to the pharyngeal nerves to contract and cause such invasive objects to be expelled.

There are no particular causes of hyperactive gag reflex as such. It’s just an aversion to certain textures of food that induces a severe urge to gag. Certain activities that need you to open your mouth for a long time or putting something in the mouth can also result in a gag. Basically, anything that brushes against the soft palate and stimulates it, results in a gag. Adults may experience it while getting a dental job done, which requires the person to keep his mouth open for a very long time. Moreover, during a dental job, certain instruments or solutions stimulate the soft palate and aggravate the feeling to gag.

Symptoms:

Hyperactive gag reflex is characterized by high sensitivity levels in the pharyngeal nerves and surrounding area of certain individuals which leads to evocation of gag reflex at the slightest instance. This overactivity of the gag reflex is generally experienced by infants who are often not able to swallow their food properly and tend to throw up much of it. Overactive gag reflex causes in adults, though rare, may include sensitivity to certain foods, reactions to some sort of medication, indulging in activities that involve high intensity movements such as swimming, running, etc. Hyperactive gag reflex often include dental treatment sessions and indulging in prolonged periods of excessive laughter.

Diagnosis:

The gag reflex is elicited by touching the posterior pharyngeal wall, tonsillar area, or the base of the tongue, with the tip of a thin wooden (“orange”) stick; depressing the tongue with a wooden spatula, and the use of a torch for illumination of the posterior pharynx, may be required to get a good view. There is a palatal response (palatal reflex), consisting of upward movement of the soft palate with ipsilateral deviation of the uvula; and a pharyngeal response (pharyngeal reflex or gag reflex) consisting of visible contraction of the pharyngeal wall. Lesser response include medical movement, tensing, or corrugation of the pharyngeal wall. In addition there may be a head withdrawal, eye watering, coughing, and retching. Hence there is a variability of response in different individuals. Some studies claim the reflex is absent in many normal individuals especially with increasing age, without evident functional impairment; whereas others find it in all healthy individuals, although variable stimulus intensity is require to elicit it.

The afferent limb of the reflex area is the glossopharyngeal nerve, the efferent limb in the glossopharyngeal and vagus nerve. Hence individual or combined lesions of the glossopharyngeal and vagus nerves depress the gag reflex, as in neurogenic bulbar palsy.

Dysphagia is common after a stroke, and the gag reflex is often performed to assess the integrity of swallowing. Some argue that absence of the reflex, since it may be normal in elderly individuals, does not predict aspiration and is of little diagnostic value, whereas pharyngeal sensation (feeling the stimulus at the back of the pharynx) is rarely absent in normals and is a better predictor of the absence of aspiration. Other find that even a brisk pharyngeal response in motor neurone disease may be assoicated with impaired swallowing. Hence the value of the gag reflex remains debatable. A videoswallow may be a better technique to assess the integrity of swallowing.

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Hyperactive Gag Reflex Treatment:

It is possible to get rid of your hyperactive gag reflex through desensitization, which means training your soft palate to receive objects without gagging. The best time to train your soft palate is when you’re brushing your teeth. Do the following steps while you’re brushing, and get rid of your gag reflex as soon as possible.

Find out where the gag reflex starts. Use the toothbrush to brush your tongue. Start from the farthest tip of your tongue, then work your way in deeper.

• Once you begin to gag, try to brush that area for about 10 seconds even while you’re gagging. This process is quite unpleasant, but training yourself not to gag naturally involves some gagging. Stop brushing when you feel like you can’t continue any longer; training yourself can’t be done in a day.
• Repeat the process over the next few days, concentrating on the exact same spot. You’ll notice that you gag less each time you repeat it. Stay on the same spot until you can handle most of the gagging or gagging completely stops. That part of your mouth is now desensitized.
• Reach deeper into your mouth using the toothbrush. Try brushing half an inch behind the desensitized spot. Keep moving further back until you’ve reached the farthest area that the brush can reach.

The whole desensitization process should take about a month to complete, so don’t lose hope if nothing improves in the first couple of days. When desensitization is complete, your doctor can swab the back of your throat all he wants, and you won’t gag at all. Remember to repeat the process from time to time because your gag reflex may return if you don’t.

Don’t start too far back because you’ll only gag pointlessly. This process only works if you do it one tiny step at a time.

• It’s not advisable to do this twice a day because if you vomit your food, then your body won’t be able to digest the nutrients it needs. Do it once either in the morning or before you go to sleep in the evening.
• Don’t breathe through your mouth while you’re brushing; instead, breathe through your nose to avoid triggering the gag reflex.
• You may want to talk to your doctor first before desensitizing your soft palate. This training is also not recommended for children, as they might choke on the toothbrush.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.