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Dysphagia Frequently Asked Questions (FAQ)

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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