1. What is dysphagia?
Dysphagia (dis-FAY-juh) refers to a swallowing disorder characterized by difficulty with chewing, manipulating, and moving food, liquid, medications, or secretions through the mouth, throat, and esophagus into the stomach. Dysphagia is experienced by millions of older adults. Some studies estimate that up to 22% of adults over the age of 50 suffer from dysphagia.
Dysphagia can result from many medical conditions.
Signs and symptoms include:
- Coughing or choking when eating or drinking
- Food sticking in the mouth or throat
- Difficulty chewing
- Wet sounding voice
- Upper respiratory infections
- Pneumonia or other respiratory disorders
2. How do we swallow?
Approximately 40 mouth and throat pairs of muscles and many nerves are required for the complex, coordinated act of swallowing. The tongue propels food into the throat, which sends it on to the esophagus and stomach. During the transition from the mouth to the esophagus, the food sits next to the larynx and trachea (windpipe), which lead directly to the lungs. In normal swallowing, the larynx and vocal folds are closed in order to protect the airway while the sphincter muscle at the top of the esophagus opens to let food pass. If the strength or timing of the muscles and nerves responsible for bolus propulsion or airway closure are disrupted, food or liquid may be misdirected into the airway resulting in aspiration.
3. Why is dysphagia a concern?
If left untreated dysphagia can lead to aspiration, the entry of foreign material (such as food, liquid, or secretions) into the airway. Aspiration increases the risk of developing pneumonia. Dysphagia can cause malnutrition, dehydration, decreased quality of life, weight loss, and even death.
4. Who is at risk for dysphagia?
Dysphagia affects nearly 15 million adults and many millions of infants and children in the US alone. It is a global condition, affecting men, women, and children worldwide. Dysphagia commonly results from conditions such as stroke, dementia, Parkinson’s disease, or a wide variety of neuromuscular diseases. Swallowing difficulties may also occur in patients with head and neck cancer or injury. Additionally, swallowing changes caused by declining muscle strength through the body that occur with natural aging make older adults more vulnerable for developing dysphagia.
5. What are the common signs and symptoms of a swallowing problem?
If you notice the following in yourself or someone you know, you might suspect a swallowing disorder:
- Coughing or choking when eating, drinking, or taking medication
- Food sticking in the mouth or throat
- Drooling
- Difficulty chewing
- Wet sounding voice
- Unplanned weight loss
- Pneumonia or other respiratory infections
6. Who diagnoses and treats a swallowing problem?
A speech language pathologist (SLP) with special skills and knowledge in swallowing disorders is typically 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.
7. How is a swallowing problem diagnosed?
The clinician (usually a speech language pathologist) who evaluates swallowing typically will:
- take a careful history of medical conditions and symptoms
- look at the strength and movement of the muscles involved in swallowing
- observe posture, behavior, and oral movements during eating and drinking
- possibly perform special tests to evaluate swallowing, such as:
- videofluoroscopic swallowing evaluation – individual eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on a moving X-ray
- endoscopic assessment – a lighted scope is inserted through the nose, and then the swallow can be viewed on a screen
8. If I suspect my family member or friend has a swallowing problem, what should I do?
Notify your primary care physician, who can write a referral to a speech language pathologist who specializes in the diagnosis and treatment of dysphagia.