Swallowing Disorder

What is a Swallowing Disorder?

It is defined as difficulty in swallowing, the inability to swallow, or a condition in which swallowing is difficult or painful.

There are 4 phases of swallowing :

  • 1. Oral Preparatory Phase : Food is chewed and manipulated in the mouth.
  • 2. Oral Phase : The tongue moves to push food toward the back of the throat to “trigger” the swallow.
  • 3. Pharyngeal Phase : After the swallow is triggered, the food (also known as a bolus) moves down the upper portion of the throat known as the pharynx.
  • 4. Esophageal phase : The food moves past the pharynx and enters the esophagus where it moves further down into the stomach.

A person with a swallowing disorder has a problem at one or more of these phases.

We have 2 “tubes” in our throat. One “tube” known as the trachea (or airway), is where air goes in and out of our lungs and past our vocal cords.

The other “tube” known as the esophagus, is where food and liquid go down into the stomach.

Penetration is when food or liquid goes into the trachea and stays above the vocal cords.

Aspiration is when food or liquid goes into the trachea and goes below the vocal cords.

Both of these are “undelightful” to experience.

If you have ever breathed in with food or liquid in your mouth, you know what I’m talking about. 

You probably coughed uncontrollably. Your face turned red, your eyes watered, and when people asked if you were alright, you might have said…

…it went down the wrong pipe.

Coughing is the body’s way of getting food, liquid, and any other object out of the airway. It also keeps things from going into the lungs.

Coughing is a good thing because that means the body feels something go into the airway.

The problem comes when a person has food or liquid go into their airway…

…and they don’t feel it.

This is called silent aspiration.

The only way this can be detected is through imaging studies such as a modified barium swallow study or MBS (see details below).

There are many signs and symptoms of swallowing difficulty or dysphagia. Some are :

  • Inability to recognize food
  • Difficulty placing food in the mouth
  • Inability to control food or saliva in the mouth
  • Coughing before, during, or after a swallow
  • Frequent coughing at the end of a meal or right after
  • Weight loss when no other reason can be defined
  • Wet vocal quality (speech sounds gurgly)
  • Pneumonia
  • Malnutrition
  • Dehydration

What Can I Do About It?

The best thing you can do if you or someone you care for has dysphagia, is to follow the advice of the Speech Pathologist who treats you.

When necessary they will recommend a specific diet to follow.

Follow it…it’s for your safety!

As a hospital intern I remember observing a patient of mine who was not supposed to eat anything, in medical terms this is called NPO (nothing by mouth or “nil per os” in Latin)

I walked into his room one afternoon to see him lying on his back eating a cheeseburger.

My supervisor and I were speechless and she was very upset with him

If you want to…

  • spend more time in the hospital
  • increase your chances of pneumonia
  • improve your chances of dying

…by all means, don’t follow the diet recommendation.

The SLP may give you exercises and other suggestions. Practice your exercises as often as possible and follow the suggestions for eating.

Some examples of eating suggestions may be:

  • person should be well rested
  • sip don’t pour liquids into the mouth
  • remove distractions (if person is easily distracted)
  • person should be seated upright at a 70-90 degree angle
  • encourage the person to chew well before swallowing
  • encourage the person not to talk while eating

Additionally, there are a variety of techniques an SLP can give someone with dysphagia that will be specific to what problem(s) they are having, such as:

  • a chin tuck
  • head turn toward weak side of the body
  • re-swallow

An SLP should discuss these with you and help you use them at home.

Dysphagia Causes – What Are They?

There are many different causes of dysphagia. Some common causes are:

Neurological disorders

  • Cerebrovascular accident
  • Parkinson’s disease
  • Alzheimer disease
  • Dementia etc.

Neuromuscular disorders

  • Amyotrophic lateral sclerosis (known as ALS or Lou Gehrig’s disease)
  • Multiple sclerosis
  • Muscular dystrophy etc.

Other causes

  • Head and neck injuries
  • Cancer or tumors
  • Throat surgeries

There are other causes of dysphagia but these are more common ones.

If you suspect that you or your loved one has dysphagia see your doctor right away. Some possible signs may include:

  • momentary loss of voice
  • complaints of something caught in throat
  • decreased appetite
  • weight loss
  • difficulty in chewing
  • throat clearing
  • watery eyes (after eating)
  • wet voice quality (after swallowing)
  • runny nose
  • person gets a temperature 30-60 minutes after eating
  • person refuses to eat certain foods
  • loss of food from mouth

What Does it Affect?

The most vital thing swallowing disorders affect is…your life!

If you consistently swallow food or liquid into your lungs, you can develop pneumonia (water in the lungs).

If your lungs get filled with water, that means there is less room for oxygen.

Without oxygen…you die.

For safety reasons, a person with a swallowing disorder may be limited to the food they can eat or require a feeding tube.

This would definitely affect your quality of life and could cause malnutrition.

I’m sure we all agree, that not being able to eat what you want…

…would be awful.

Dysphagia Treatment: What Can Be Done? What Does an SLP Do To Help?

Dysphagia treatment consists of non-imaging procedures and imaging studies to identify swallowing disorders.

One type of non-imaging procedure is a bedside swallow evaluation which an SLP would do in a person’s hospital room.

During this procedure an SLP gives the patient a few different things to eat and drink.

Each type of food or liquid has a different thickness. This helps the SLP determine if a person has an easy or hard time swallowing it.

A thin liquid (like water) is harder to swallow because it moves very fast in the mouth and splashes down the throat.

A thicker liquid (honey or puree applesauce) moves slower and allows more time for parts in the throat to react and cover the airway.

To determine the appropriate dysphagia treatment…

…an SLP observes the person while eating to see:

  • If they have food in their mouth after they swallow
    This could mean they have weak muscles and less sensation in their mouth. The leftover food could also eventually go down their throat and into their airway or they could choke on it.
  • If their voice quality changes they have after each swallow
    This could mean food or liquid is going into the airway.
  • If they cough before, during, or after the swallow
    This could mean food or liquid is going into the airway.

If an SLP suspects dysphagia, they will confirm it by doing an image study.

modified barium swallow study (MBS) is one type of imaging study SLPs use to diagnose dysphagia.

This is done through moving X-rays. The patient sits in a chair and has an X-ray machine placed near their throat.

The Radiologist (X-ray doctor) or technician does the X-rays, while the SLP feeds the patient different amounts of various food and liquid that are mixed with a substance called liquid barium.

Barium has barium sulphate in it that X-rays cannot pass through. As a result the food or liquid shows up in a moving X-ray.

This allows the Radiologist and the SLP to see if food or liquid is going into the patient’s airway.

From start to finish, a swallow takes approximately 1 – 2.5 seconds. For this reason, swallow studies can be recorded to make sure the SLP and Radiologist see everything that happens.

Once a swallow study is completed the SLP will determine how mild or severe the problem is, and determine the necessary type of dysphagia treatment.

Then the SLP can :

  • restrict or recommend a certain diet, noting foods to avoid
  • give the patient swallowing strategies or exercises to do at home
  • schedule the patient for swallowing therapy
  • schedule additional evaluations to measure progress

During therapy an SLP would help a person with dysphagia by :

  • practicing with safe swallow strategies
  • teaching exercises to strengthen tongue and swallowing muscles
  • using thermal tactile stimulation (hot/cold therapy to increase sensation in the mouth)
  • using vital stimulation when appropriate and available (electrical stimulation for the throat muscles)