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Dysphagia is another term for swallowing problems. A person who has dysphagia may experience pain when trying to swallow. Others may have difficulty swallowing food, liquid or saliva, and some people may be unable to swallow at all.

How does the swallowing process work?

Swallowing is a complex process that moves food and liquids from the mouth to the stomach. Swallowing involves the use of many nerves and muscles in the lips, tongue, mouth, throat, and esophagus, which is the tube that connects your throat to your stomach.

Swallowing occurs in four stages:

• Oral preparatory stage: food is chewed and prepared for swallowing;
• Oral stage: the tongue pushes the food or liquid to the back of the mouth;
• Pharyngeal stage: the swallow is triggered and the food or liquid is moved into the pharynx (the canal that connects the mouth to the esophagus); and
• Esophageal stage: food or liquid enters the esophagus and is carried into the stomach.

Why would I develop a problem swallowing?

Any condition that damages or weakens the muscles and nerves used for swallowing can cause swallowing problems, such as:

• Having a stroke, or an injury to the head or spinal cord
• Diseases that affect muscles, such as muscular dystrophy
• Other brain or nerve diseases, such as Parkinson’s disease and multiple sclerosis
• Alzheimer’s disease and other kinds of dementia
• Head and neck tumors
• Side effects of certain medications

How can I tell if someone I know has swallowing problems?

Symptoms of dysphagia include:

• Choking on food, liquids, and medications, or food or liquid coming out of the nose
• Coughing during or right after eating or drinking
• Wet or gurgly sounding voice during or after eating or drinking
• Extra effort needed to chew and swallow
• Difficulty squeezing food or liquid down the throat
• Pocketing of food on one side of the mouth
• Excessive drooling

What should I do if I think I have a swallowing problem?

You should consult your health care provider to find out if there is a serious problem, and what the cause might be, so treatment can be suggested. If the swallowing problem is in the first three stages, you may be referred to a speech-language pathologist. If the problem is in the last stage of swallowing, you may need other treatment. It is important to treat swallowing problems since they can lead to serious health problems, such as: poor nutrition and dehydration; loss of appetite and discomfort; less enjoyment of eating; embarrassment in social situations involving eating; choking on food or liquids; and, food or liquid entering the airway (aspiration), which can lead to lung infections and possibly pneumonia.

How are swallowing problems diagnosed?

A physical exam of the strength and movement of the muscles involved in swallowing—including the lips, tongue, chewing function, palate, and throat—must be conducted. Following the exam, additional testing may be recommended, including:

• Videofluroscopic Swallowing Study: A radiologist and a speech-language pathologist conduct this study together. During this x-ray study you swallow a chalky substance called barium, usually mixed with food or liquid. X-rays are taken of the food and barium combination as it enters the oral cavity and travels into the esophagus.
• Fiberoptic Endoscopic Evaluation of Swallowing: This involves the passing of an endoscope (a thin flexible tube) through the nose and down your throat. This is performed by an endoscopist (either a Speech-Language Pathologist or Otolaryngologist), and another person who assists and feeds the person with the swallowing problem.
• Barium X-ray: This study involves the drinking of a barium solution, which coats the inside of the esophagus. The doctor can see changes in the shape and movement of muscles of your esophagus on the x-ray.

What are some of the treatments available?

Depending on the cause, symptoms and type of swallowing difficulty you have, treatments may include:

• Changes in positioning or posture
• Teaching you different ways to swallow more safely
• Changes in the feeding process; changing the thickness of the liquid of food; and preparing foods in a certain way that is safer for you to swallow
• Exercises to strengthen or improve your swallowing muscles

Where can I get more information about swallowing problems?

• American Speech-Language Hearing Association
  10801 Rockville Pike
  Rockville, MD 20852
  800-638-6868
  Website: www.asha.org
  
  
• American Academy of Otolaryngology—Head and Neck Surgery
  1 Prince Street
  Alexandria, VA 22314
  703-836-4444
  Website: www.entnet.org
  
  
• Dysphagia Resource Center
  Website: www.dysphagia.com

 

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