What is Dysphagia?
Dysphagia (dis-FAY-juh) is a disorder that means an
individual is having difficulty swallowing. Dysphagia
may impact one's ability to chew, manipulate and move
foods, liquids, secretions or medications through the
mouth, throat, and esophagus into the stomach.
Who does
Dysphagia affect?
Dysphagia impacts close to 15 million Americans.
Approximately 1 million individuals receive a diagnosis
of dysphagia annually. Dysphagia may affect men, women
and children.
What are some commons causes of Dysphagia?
Dysphagia commonly results from stroke and other
traumatic brain injuries (TBI). However, dysphagia can
also result from Dementia, Parkinson's disease,
Neurodegenerative diseases (e.g., Amyotrophic Lateral
Sclerosis, Multiple Sclerosis) Head and neck cancer,
other trauma (injury to head/facial/neck region), and
natural aging in the elderly.
What are some Signs
and symptoms of Dysphagia?
There are many signs and symptoms of Dysphagia.
Some may include coughing or choking during eating,
drinking or taking medications, difficulty chewing, and
drooling. Additionally, other signs and symptoms are
increased chest congestion or secretions, food sticking
in the mouth or throat, wet, gurgly vocal quality,
pneumonia or other respiratory infections or disorders,
unplanned weight loss, malnutrition or dehydration, and
avoiding eating are common signs of Dysphagia.
Who diagnoses and
treats a swallowing problem?
A speech language pathologist (SLP) with special
training in swallowing disorders is the primary
individual responsible for diagnosing and treating
dysphagia. Some SLPs are board certified in Swallowing
and Swallowing Disorders by the American Board of
Swallowing and Swallowing Disorders (ABSSD).
What are some
different treatment methods for people with dysphagia?
The speech language pathologist (SLP) will formulate a
plan that may include compensatory strategies or
maneuvers that may improve the flow of food or liquid
through the mouth and throat. The SLP may also provide
information regarding changing the textures or
consistencies or the food and liquid for safer and more
efficient swallowing.
The SLP may also put together an exercise program to
target specific muscles in the mouth and throat to help
improve your swallowing. *Since each treatment plan is
patient specific and there are multiple interventions
available, it is recommended that you follow the
guidelines provided specifically to you by a certified
SLP. Many of these exercises and maneuvers can be found
on our treatment program, "The
Educational Video for Individuals with Dysphagia".
Why is dysphagia a
concern?
Aspiration, or the entry of foreign material (food,
liquid, secretions, medications) into the airway/lungs
puts an individual at risk for developing pneumonia,
which can be life threatening. Dysphagia may also result
in malnutrition, dehydration, weight loss, decreased
overall quality of life, and even death.
How do we swallow?
Swallowing is a complex process that involves the
coordination of multiple muscles and nerves. The tongue
works to move food onto the teeth for chewing and to
propel food towards the back of the throat to be
swallowed. The muscles of the throat work to squeeze the
food down towards the esophagus where the food is
carried to the stomach. The airway (windpipe) and
esophagus are very close together and even share a wall.
When the food or liquid is being passed from the mouth
to the esophagus, the larynx and vocal folds, which lie
at the top of the airway, are closed shut in order
prevent any material from going 'down the wrong pipe'.
If the strength of the muscles or the timing and
coordination of the muscles and nerves are affected, the
airway closure may be impaired. Food may then enter the
airway, resulting in aspiration.
What other medical
professionals may be involved in treating Dysphagia?
There are other medical professionals that may be
involved in the treatment and management of dysphagia.
Some of these professionals may include
Dieticians/Nutritionists, Respiratory Therapists, Ear,
Nose and Throat Doctors (Otolaryngologist),
Gastrointestinal Doctors (GI), Dentists, Neurologists,
Nurses, Occupational Therapists, Radiologists,
Psychologists, Social Workers, and Physiatrists.
How is a swallowing
problem diagnosed?
A speech-language pathologist will perform a
swallow evaluation which typically includes: Obtaining a
case history including any pertinent medical conditions
and symptoms, evaluating the strength and movement of
the muscles involved in swallowing, observing posture,
feeding behaviors, and oral movements during eating and
drinking.
What is a Modified
Barium Swallow?
If deemed appropriate and necessary, a speech-language
pathologist may recommend further testing be performed
to further evaluate the swallow, such as a
Modified Barium Swallow Study (also referred to as the
videofluoroscopic swallowing evaluation). This test
takes place in the radiology department of the hospital
and can be done as both an inpatient or outpatient.
How is a Modified
Barium Swallow performed?
For this test, the individual eats or drinks food or
liquid with barium in it, and the swallowing process is
viewed on a moving X-ray. The clinician and radiologist
are present for the evaluation and following the
procedure the speech pathologist will provide the
individual and/or family regarding the results,
diagnosis and safest foods/liquids to consume.
What is Endoscopic
swallowing assessment?
Endoscopic swallow assessment (also referred to as
Fiberoptic Endoscopic Evaluation of Swallowing or FEES).
A lighted scope is inserted through the nose and passed
right to the level of your uvula in your throat. The
swallow can be viewed on a screen with the scope in
place. The individual ingests food and liquid with color
dye in it (usually blue or green) and the clinician can
view the any swallow abnormalities.
How is Endoscopic
swallowing assessment used in evaluating Dysphagia?
During these tests, the clinician is able to view if
food or liquid is going into your airway instead of your
stomach (aspiration). This will allow the clinician to
see what parts of your mouth and throat may not be
working properly as well as determine what kinds of food
are safest for you to swallow. The clinician may also
try different body positions or strategies that may help
you swallow better.
What should I do if I
suspect my family member / friend has a swallowing
problem?
Notify your primary care physician immediately. At this
time the physician can write a referral to a speech
language pathologist who specializes in the diagnosis
and treatment of dysphagia.
Are there different
types of Dysphagia?
Oral dysphagia is characterized by difficulty in
accepting food or liquids into the mouth, problems with
chewing food or difficulty controlling the food or
liquid and transporting it to the back of the mouth to
be swallowed.
Pharyngeal dysphagia occurs when the individual has
difficulty swallowing food or liquid in order to bring
the food or liquid down to the esophagus. This may
result in food or liquid being redirected down into the
larynx ('the wrong pipe') and into the lungs.
Esophageal dysphagia is characterized by swallowing
difficulties when the food has entered the esophagus
(passageway to the stomach).
What is the aspiration
and penetration of food and liquids?
The speech language pathologist may also describe to you
that penetration or aspiration was noted when you
underwent an X-Ray swallow test (Modified Barium Swallow
Study) or during Endoscopy. Terms such as penetration
and aspiration are often used to describe when food or
liquid enters the airway (where it is not supposed to
go).
What is the difference
between aspiration and penetration of food and liquids?
Penetration is when food or liquid goes into the trachea
(airway) and stays above the vocal cords (meaning it
does not go all the way down into your lungs).
Aspiration is when food or liquid goes into the trachea
and goes below the vocal cords.
What happens if there
is aspiration or penetration of food and liquids during
swallowing?
Often times, people will cough when this occurs.
However, there are instances when a person may aspirate
material into the airway and they cannot feel it. This
is referred to as silent aspiration (see below).
What is silent
aspiration?
The only way to detect silent aspiration is through
imaging studies such as a modified barium swallow study.
Under X-ray, the SLP can see if food or liquid is
entering the airway and can take note of the person's
response when the food or liquid goes into the airway
(e.g., coughing, clearing throat). Silent aspiration is
dangerous, as the individual cannot feel that the food
or liquid is going down the wrong way and the person
will often not have a cough response.
Why is it important to
sit at 90 degrees when eating or drinking?
Many people with dysphagia are more at risk for food or
liquid falling into the airway because of lack of back
of tongue control. If seated in a reclined position
while eating or drinking, the person with dysphagia is
at greater risk for food or liquid to fall prematurely
into the throat and possibly into the airway.
Why is oral care so
important for people with dysphagia?
Some people with dysphagia may be at risk for aspirating
their own saliva. If there are bacteria in the mouth, it
may enter the lungs if the secretions are aspirated.
This can lead to chest infections, such as aspiration
pneumonia. Oral care is especially important for
individuals who are not currently eating by mouth and
are receiving nutrition and hydration via a feeding
tube. Mouth swabs, toothettes and mouthwashes can be
useful in maintaining adequate oral care.
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