Many medical conditions can result in Dysphagia, including stroke, dementia, respiratory illness, and more.
Dysphagia is the medical term for difficulty swallowing and can occur for a variety of reasons. A normal swallow typically includes four stages: Oral, Preparatory, Oral, Pharyngeal, and Esophageal. Dysphagia can occur during one or more swallow stages and can lead to difficulty or the total inability to swallow liquids, foods, or manage secretions such as saliva.
Many medical conditions can result in Dysphagia. Some common conditions include stroke, traumatic brain injury, GERD/Laryngeopharyngeal reflux, dementia, urinary tract infections, head and neck cancer, and respiratory illnesses such as Chronic obstructive pulmonary disease (COPD) and Acute respiratory distress syndrome (ARDS). Some medical conditions may not directly impact the swallow. However, the medications used to treat the conditions may have side-effects or even cause drug-induced Dysphagia.
Additionally, medical events requiring respiratory support such as oxygen therapy, non-invasive respiratory support (e.g., high flow oxygen, ventilation via face mask), or invasive respiratory support (e.g., endotracheal intubation) can impact the muscles of respiration and oropharyngeal musculature, resulting in impaired swallow function.
Sign and Symptoms of Dysphagia
Signs and symptoms of Dysphagia typically occur while eating/drinking but are not limited to mealtime. Obvious signs and symptoms of Dysphagia include:
- Food or liquid spilling out of the mouth
- Difficulty with or prolonged chewing
- A sensation of food or pills getting stuck within the mouth or throat
- Residue within the mouth after swallowing
- Coughing, choking, throat clearing, shortness of breath, wet vocal quality, or watery eyes while eating/drinking
Less obvious symptoms of Dysphagia can also include recurrent pneumonia/respiratory infections and fever after meals. Additionally, changes in eating habits such as avoidance of particular food/liquids may be noted, and weight loss or dehydration can occur
Problems Caused by Dysphagia
Depending on the severity of Dysphagia, serious complications can arise, such as choking, malnutrition, dehydration, or chronic lung disease. Morbidity related to Dysphagia is also a significant concern. Adults with Dysphagia may also experience disinterest in eating/drink and embarrassment or isolation in social situations that involve eating.
Treatment Options for Dysphagia
The first step typically involves consulting your physician if you have a sudden or gradual change in your ability to swallow. Your physician may then refer you to an otolaryngologist (ENT physician), neurologist, or a Speech-Language Pathologist. A speech-language pathologist diagnoses and treats Oral and Pharyngeal Dysphagia and will make appropriate referrals if there is a concern for Esophageal Dysphagia.
What is Speech Therapy
Dysphagia can be addressed by Speech Therapy services provided within multiple settings, including hospitals, Skilled Nursing, or Long-Term Care facilities such as the Comprehensive Care Center or in-home health settings. When visiting a Speech-Language Pathologist, you can expect to participate in an evaluation. Depending on your signs/symptoms, this can include a Cranial Nerve/Oral Motor Examination, Clinical Swallow Evaluation, Modified Barium Swallow Studies (MBSS), or Fiberoptic Endoscopic Evaluation of Swallowing (FEES). MBSS and FEES are instrumental assessments used to assess the swallowing stages not easily seen during a Clinical Swallow Evaluation (also referred to as a Bedside Swallow Evaluation).
During an MBSS, a clinician will take a videotaped x-ray of the entire swallowing process while the patient consumes several foods, liquids, or medication. During a FEES, a flexible endoscope is utilized to view the larynx during the swallowing process. Both instrumental assessments help to identify where in the swallowing process issues are occurring. This allows a Speech-Language Pathologist to make appropriate recommendations for any necessary Speech Therapy services.
How Speech Therapy Addresses Dysphagia
Different treatments to address Dysphagia and treatment will typically include exercise-based treatment or energy conservation strategies to improve swallow function. Results from Dysphagia evaluations also allow clinicians to explore changes that can be made to food textures, liquid consistencies, head/neck posture, or behavioral maneuvers to promote swallow safety/feeding efficiency. Additionally, Dysphagia treatment will minimize the risk of pulmonary complications, reduce patient and caregiver burden, and maximizing overall quality of life.
- National Found of Swallowing Disorders (https://swallowingdisorderfoundation.com/)
- Dysphagia Research Society (https://www.dysphagiaresearch.org/page/VEH-NFOSD)
- American Speech-Language-Hearing Association
- Adult Dysphagia (https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/)
- Pediatric Dysphagia (https://www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/)