Dysphagia: A Swallowing Disorder

For Better Speech and Hearing Month, last week we had the chance to learn about our speech-language pathologist, Teri Burns. This week we would like to share some information on one of the common disorders that she treats: dysphagia. Teri is excellent and has many years of experience working with this condition. You can call our office at 816-478-4200 to arrange an evaluation with her.

What is dysphagia?

Dysphagia means difficulty or discomfort in swallowing.  Dysphagia can occur at any of the following stages:
Oral preparatory phase:  Food is chewed and the tongue creates an appropriate size amount of food/liquid (the bolus) to be swallowed. 
Oral phase:  The tongue moves the bolus to the back of the throat. Muscles close the opening to the back of the nose. 
Pharyngeal phase:  The bolus is moved from the pharynx (the throat) to the esophagus (the tube to the stomach). 
Esophageal phase:  The bolus moves through the esophagus and into the stomach. 

Complications of dysphagia may include pneumonia, malnutrition and dehydration.

What are the symptoms?

Symptoms may include:
Inability to control food in the mouth
Coughing before, during, or after a swallow
Gurgly or “wet” voice quality
Feeling of food being “stuck” in the throat
Recurrent pneumonia
Weight loss when no other reason is identified

What can cause swallowing problems?

These problems can be a result of damage to the brain (i.e. stroke, progressive neurological diseases), problems related to the head or neck (i.e. cancer, surgery) or due to trauma because intubation/extubation from a ventilator.  They can also be idiopathic; the swallowing problem arises spontaneously from an unknown cause.  

How is it diagnosed?

A Speech Pathologist will complete a swallow evaluation.  There are two different diagnostic tests for evaluating swallowing problems.  These are FEES (fiberoptic endoscopic evaluation of swallowing) and  videoswallow. FEES is completed in the office while a videoswallow must be completed in a hospital imaging department.  

During these evaluations, impairments can be identified.  These can include:

Aspiration:  entry of food/liquid into the airway below the vocal cords 
Penetration:  entry of food/liquid into the larynx (i.e., voice box) but not below the vocal cords
Pooling:  food that enters the throat and sits in this area for an extended time prior to the initiation of the swallow
Residue:  food that is left behind in the mouth or throat after the swallow
Backflow:  food moving up from the esophagus to the pharynx; food moving up from the pharynx to the nasal cavity

What can be done to improve dysphagia?

Initially, diet modification may be warranted to improve safety of eating.  Food and liquids can be modified.  Strategies may also be used during eating to reduce the risk of dysphagia.  These may include changes to positioning (i.e. sitting up while eating, tucking chin to chest), changes to how food is presented (i.e. straw vs. cup), and use of protective techniques while eating (i.e. completing additional swallows, coughing/clearing throat throughout the meal).  Specific instructions will be provided by the Speech Pathologist when needed.

Dysphagia/Swallowing therapy may also be helpful to reduce the effects of dysphagia.  This may include an exercise program that targets the muscles involved in swallowing, electrical stimulation to these muscles, and/or use of sensory stimulation to oral structures.  The Speech Pathologist will set up a therapy program with a home program being provided when indicated.