Nasal regurgitation (NR) is the involuntary backflow of food or liquid from the throat or esophagus into the nasal passages. This event can be startling, whether it happens suddenly in an adult or occurs regularly during an infant’s feeding. When swallowing mechanics fail, liquid or food exits through the nose, causing discomfort and concern. Understanding the underlying causes helps determine if the event is a harmless anomaly or a sign of a deeper issue.
How the Soft Palate Prevents Regurgitation
The separation of the oral and nasal cavities during swallowing relies on a coordinated anatomical process. The soft palate, or velum, is a muscular structure located at the back of the roof of the mouth. During swallowing, the soft palate muscles contract and elevate. This action, known as velopharyngeal closure, seals off the nasopharynx, the upper part of the throat connected to the nasal cavity.
This closure prevents the swallowed material, known as the food bolus, from moving upward into the nose. When this muscular seal is incomplete or mistimed, the pressure generated by swallowing forces the material into the nasal passages. Failure of this velopharyngeal mechanism is the direct cause of nasal regurgitation.
Benign Causes in Infants and Children
In infants, nasal regurgitation is frequently a temporary and non-concerning occurrence, largely due to developmental immaturity. Newborns are still mastering the complex coordination required for sucking, swallowing, and breathing simultaneously. Poor synchronization can lead to milk overwhelming the system and being diverted into the nasal passages.
The digestive system also plays a significant role, as the lower esophageal sphincter (LES) is not yet fully developed. This muscular valve relaxes more easily in infants, allowing milk to flow back up from the stomach in a common occurrence known as gastroesophageal reflux (GER). Up to 67% of infants experience some form of regurgitation, sometimes including a nasal exit. Simple measures, such as keeping the infant upright during and after feeding and using paced feeding techniques, can help. This functional regurgitation typically resolves as the infant’s muscles mature, often disappearing completely by twelve to eighteen months of age.
Structural and Chronic Conditions
Nasal regurgitation that persists beyond early childhood or occurs in adults is related to more chronic or structural medical issues. A common mechanical problem is Velopharyngeal Insufficiency (VPI), where the soft palate cannot fully close the nasal opening during swallowing or speech. This insufficiency can stem from structural defects, such as a submucous cleft palate, or from scar tissue following prior surgeries.
Neurological conditions can also impair the swallowing process, leading to neurogenic dysphagia. Diseases that affect the nerves or muscles, such as a stroke, cerebral palsy, or muscular disorders, can prevent the coordinated contraction of the soft palate and pharyngeal muscles. The resulting weakness means the velopharyngeal sphincter cannot reliably close, causing backflow.
Chronic Gastroesophageal Reflux Disease (GERD) is another potential cause, distinct from the mild GER seen in infants. GERD involves frequent backflow of stomach acid and contents into the esophagus, which can sometimes reach the throat and then the nose. This type of regurgitation tastes bitter or sour, indicating it has mixed with stomach acid, unlike a primary swallowing problem involving unmixed food.
When to Consult a Medical Professional
While occasional nasal regurgitation is common and harmless, several warning signs indicate a need for professional medical evaluation. If the regurgitation is persistent and does not resolve after the first year of life, it may signal an underlying structural or functional issue. Poor weight gain or a failure to thrive, particularly in infants, is a sign that the body is not receiving adequate nutrition due to feeding difficulties.
Recurrent respiratory problems, such as frequent coughing, choking, or chest infections, are also concerning, as they suggest the regurgitated material is being aspirated into the lungs. Any change in voice quality, such as a wet or gurgly sound after eating, points to possible laryngeal involvement. A physician should also be consulted if nasal regurgitation is accompanied by obvious facial or palatal structural anomalies.