Most of us spend more time thinking about what we are going to eat rather than how we will eat. But if you have dysphagia, your focus is often on the latter. It can be difficult, frustrating, even disheartening to work through this condition, but SLPs are here to help you and your loved ones identify issues and learn the best techniques to swallow safely and enjoy eating and drinking again. To understand this complex issue, let’s first review some of the basics of eating and swallowing:

-You put the food/drink in your mouth and chew or move the food/liquid around (we call this the Oral phase)

-You squeeze your throat to move the food down (we call this the Pharyngeal phase)

-We don’t generally pay attention to this part unless we suffer from reflux, but our esophagus (the tube in the throat that food/drink goes down) opens so the food can enter the stomach (we call this the Esophageal phase).

Problems can arise at any stage of the eating and swallowing process, causing you to drool, cough, or choke, for food to get stuck, or it may make you vomit. Swallowing in general may feel painful. Food or drinks that don’t get swallowed properly can get stuck in the lungs and cause a respiratory infection called aspiration pneumonia. Aspiraation pneumonia is a serious consequence of unmanaged dysphagia which can require specialized medical treatment and even be life threatening.

What Causes Swallowing Problems?

About one in 25 adults experience a swallowing problem in the United States every year (Bhattacharyya, 2014). Overall, about 15-22% of adults ages 50+ years old in the general population have dysphagia, more than 60% of adults in skilled nursing facilities (SNFs) have dysphagia, and more than 33% of stroke patients have dysphagia.

There are many causes of dysphagia, including (but not limited to):

-stroke

-traumatic brain and spinal cord injuries

-dementia

-Parkinson’s disease

-multiple sclerosis

-amyotrophic lateral sclerosis (ALS, aka Lou Gehrig’s disease)

-developmental disabilities in an adult population (e.g., intellectual disability)

-head and neck cancer and as a side effect of certain cancer treatments

-metabolic disturbances (e.g., hyperthyroidism)

-infectious diseases like COVID-19 and AIDS

What Should I Do If I Have Trouble Swallowing?

If you have concerns about your swallowing, you should talk to your doctor asap about getting tested. An SLP is the preferred provider for dysphagia services, so you will likely be sent to an SLP for a screening or full evaluation.

What Happens During An Evaluation?

If it is recommended that you get an evaluation, there are certain steps you will go through to see what and where the issues are.

First, the SLP will screen you, which includes:

-Interviewing you about your health, past illnesses, surgeries, and swallowing problems.

-Watching how well your mouth muscles move.

-Watching you eat and seeing what happens when you swallow.Based on what they observe during the screening, the SLP will then decide whether specialized tests (called instrumental procedures) are needed. These tests are the only way to actually see your swallow as it’s happening, to know for sure what and where the problem is. If the SLP determines that more tests are needed, you may do one or more of the following:

• Modified barium swallow (MBS) – During this test, you will eat or drink with liquid barium in it and then be x-rayed. The barium shows up on the x-ray so the SLP will be able to see where the food/liquid goes when you swallow. It is safe to consume small amounts of liquid barium and it will later pass through your system.
• Endoscopic assessment (FEES) – During this test, your doctor or SLP will put a thin, flexible tube with a light and a camera on it through your nose and down your throat. The area will be anesthetized ahead of time, so it will not feel as uncomfortable as it sounds! The camera allows the doctor or SLP to see in real time what happens when you swallow, to help identify what and where the problem is. Dysphagia is a serious condition that requires specialized medical attention. It can be challenging for the person with dysphagia and their family/caregivers, but with the right treatment, it is a manageable condition and many people are able to eat and drink again safely and with enjoyment. Please call your PCP or local speech-language pathologist if you have questions or concerns about you or a loved ones’ swallowing.

Helpful Links:

-ASHA’s (SLP website) information for the public on swallowing disorders

-Mayo Clinic’s information and diagrams about dysphagiaWritten by: Naguine Duncan, M.A., CCC-SLP, bilingual certification References:

American Speech-Language-Hearing Association. (n.d.). Adult dysphagia. American Speech-Language-Hearing Association. Retrieved April 30, 2023, from https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/#collapse_5

American Speech-Language-Hearing Association. (n.d.). Swallowing disorders in adults. American Speech-Language-Hearing Association. Retrieved April 30, 2023, from https://www.asha.org/public/speech/swallowing/swallowing-disorders-in-adults/