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When to Worry About Nasal Regurgitation

Written by Dr. Michael Ruscio, DC on February 4, 2025

Written by Dr. Michael Ruscio, DC on February 4, 2025 — Reviewed by Hilary Watts

• Nasal Regurgitation|
• Causes|
• Diagnosis|
• Treatment|

If you’ve ever laughed when taking a drink or eating a bite of food, you may have experienced nasal regurgitation. Having foods or beverages enter your nose like this can cause some uncomfortable symptoms but it isn’t necessarily a cause for concern.

However, if it happens frequently, it could be a warning sign of a larger swallowing problem that needs to be addressed. Before getting into treatment, let’s take a look at the causes and symptoms of nasal regurgitation and the health issues it’s associated with.  

What is Nasal Regurgitation?

Nasal regurgitation is the movement of food or fluid up into the nose during swallowing.   

During nasal regurgitation, the nasopharynx (the top part of the throat that connects the nose to the respiratory system) doesn’t close properly, which allows food and liquid to end up in the wrong place 1. 

Nasal regurgitation may happen randomly if you laugh or breathe heavily when you try to swallow. But it can also be a symptom of a swallowing disorder or velopharyngeal sphincter dysfunction (VPD).

What Are The Symptoms of Nasal Regurgitation?

Having foods and beverages end up in your nose when you eat is the tell-tale sign of nasal regurgitation. But since nasal regurgitation is often the result of  a swallowing disorder, other symptoms to be aware of include 1 2 3: 

• Dysphagia (difficulty swallowing foods or liquids or a sensation of food sticking to your throat)
• Odynophagia (painful swallowing)
• Coughing during or immediately after swallowing
• Choking
• Drooling
• Sore throat
• Hoarseness
• Shortness of breath
• Chest discomfort or pain
• Posture changes
• Weight loss
• Repeated chest infections or pneumonia 
• Bronchitis (lung inflammation)
• Changes in voice, articulation, speech, and language
• Having to swallow repeatedly
• Frequent throat clearing
• Dehydration
• Aspiration pneumonia (infection due to food and liquid passing into the airway)
• Malnutrition

If you experience any of these symptoms routinely, it’s time to worry about and investigate the root causes.

What Causes Nasal Regurgitation?

During normal swallowing, the soft palate goes up and contacts the back and sides of the throat (pharynx), which closes off the nasopharynx and prevents the regurgitation of food or liquids into the nasal cavity 4. 

These coordinated muscle movements allow us to swallow food easily. When this process becomes dysfunctional, you can experience nasal regurgitation and aspiration 4.

Any swallowing disorder can cause nasal regurgitation but the two most common root causes include 2 5:

• Oropharyngeal dysphagia (difficulty moving food from the mouth into the throat)
• Velopharyngeal sphincter dysfunction (VPD)

The velopharyngeal sphincter consists of the soft palate (velum) and the back and sides of the pharynx (throat), all of which are critical for proper swallowing. 

In VPD, the soft palate in the mouth fails to form an effective seal between the nasal and oral cavities 1 5. People with VPD may have altered speech or voice changes, but they can also swallow air or aspirate (food or liquid entering the lungs) 6. 

Nasal regurgitation may also be caused by esophageal dysphagia (the sensation of food getting stuck in the base of the throat or chest). 

Here’s a table summarizing the many causes of both dysphagia and VPD:

Nasal regurgitation can also result from a combination of oropharyngeal dysphagia and esophageal dysphagia. This mixed dysphagia often causes gastroesophageal reflux disease (GERD) and possibly laryngopharyngeal reflux 9. 

Here are some of the risk factors that increase the likelihood of mixed dysphagia as we get older 9:

• Decreased saliva production
• Poor jaw strength
• Loss of jaw muscle
• Gum and dental problems
• Loss of upper esophageal sphincter elasticity 9

It’s important to mention here that GERD and swallowing disorders have overlapping symptoms 10 11:

• Chest pain
• Throat clearing
• Hoarseness
• Feeling a lump in the throat
• Bronchitis
• Pneumonia
• Dysphagia
• Odynophagia 

Because the symptoms can be similar, it may be difficult to determine whether your symptoms are related to GERD or a swallowing disorder. 

But there’s a difference between the type of regurgitation that signals a swallowing disorder and the type that signals acid reflux/heartburn or GERD—the taste of the food bolus (the mixture of chewed food and saliva) that comes back up. 

If the bolus tastes like the food you’ve just tried to swallow, chances are the nasal regurgitation is a result of a swallowing disorder. If it tastes bitter or sour, that’s typically stomach acid, which means the food made its way to the stomach and then came back up, which may signal GERD. 

How Do You Diagnose Nasal Regurgitation?

Rather than being a disease itself, nasal regurgitation is a symptom. So, if you’re routinely having food or liquid enter your nose when you eat, it’s important to speak with your doctor right away.

When it comes to diagnosing both dysphagia and VPD, your doctor will start by taking a thorough history. They may also order certain types of imaging to see how foods and liquids move in your throat as you swallow.  

Diagnosing Velopharyngeal Sphincter Dysfunction 

When diagnosing VPD, your doctor will review your medical history and perform a physical examination. They may also ask about your sleep history (to see if you’ve had sleep apnea, snoring, restlessness, or other problems) and possibly watch you eat or drink to see if nasal regurgitation occurs 6. 

You may be referred to a speech-language pathologist to check your speech quality for hoarseness, nasal tones, or other issues. They may also look at nasometry, which measures the ratio of sound coming from your nose and mouth 5.

To determine if there are any structural abnormalities or evidence of other causes of VPD, your doctor may also recommend a video-nasal endoscopy, a multiview videofluoroscopy (an x-ray that examines how you swallow), cephalometrics (measurements of the dimensions of your head), or an MRI.

Diagnosing Dysphagia

When diagnosing dysphagia, your clinician will review your medical history and symptoms, and conduct a physical exam. You’ll likely be referred to a speech-language pathologist. 

Swallowing function can be assessed with various screening tools such as 2: 

• Toronto Bedside Swallowing Screening Test
• Volume-viscosity Swallow Test
• Standard Swallowing Assessment
• Guggen Swallowing Screen

Additional imaging tools to assess swallowing function include 12:

• Videofluoroscopy (modified barium swallow)
• Fiberoptic endoscopic evaluation
• High-resolution manometry
• Functional imaging probe
• Accelerometry

Diagnosing esophageal dysphagia may involve the following tests 12:

• Endoscopy with biopsy
• Videofluoroscopy (barium swallow)
• Esophageal manometry
• Intraluminal impedance
• Impedance planimetry

There’s no need to know or understand all of these terms. If your doctor wants to use one of these tests, they will explain the process to you.

How to Treat Nasal Regurgitation

Treating nasal regurgitation means addressing the root cause, either VPD or dysphagia. Here’s a table of common interventions:

The earlier the intervention, the better. Getting a diagnosis as soon as possible is especially important for children who may still be developing speech habits and patterns. 

Most physicians will start with speech therapy for children to avoid surgical procedures (unless absolutely necessary) 5. If surgery is needed, it’s effective for improving nasal resonance, speech intelligibility, swallowing, and obstructive sleep apnea 16. 

And for people with oropharyngeal dysphagia, swallowing exercises can improve swallowing but also reduce the length of hospital stay and incidence of chest infection or pneumonia 17.

Identify and Treat the Root Cause of Nasal Regurgitation

Nasal regurgitation is a sign of a potentially serious swallowing disorder like velopharyngeal dysfunction, oropharyngeal dysphagia, or a mix of oropharyngeal dysphagia and esophageal dysphagia. 

If left untreated, both quality of life and health can suffer. Whether it’s due to social anxiety from abnormal speech, reduced enjoyment of food, or something more serious like chronic chest infections or aspiration pneumonia, the consequences of leaving these health issues unchecked are serious. 

If you’re experiencing nasal regurgitation it’s very important to speak with a trusted healthcare provider quickly. If you would like support on your health journey, please reach out to us at the Ruscio Institute for Functional Health. 

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