Dysphagia is an impairment in the ability to swallow effectively or safely. Swallowing is considered a complex system, including oral, pharyngeal, and esophageal stages.
Swallowing impairments can occur for a variety of reasons. Structural issues or nervous system disorders may cause these swallowing impairments, or they can occur due to medical issues, head injuries or neck surgery. No matter the reason, there is treatment.
Swallowing disorders may be caused by structural issues, weakness, incoordination, and more. Oropharyngeal dysphagia can look like choking or coughing after drinking or swallowing something, leaving food residue in the mouth or throat after swallowing, and having to clear the throat repeatedly. These are more common, but not the only signs, that an adult may have difficulty swallowing.
The three phases of swallowing include the oral phase (oral preparatory stage and oral transit stage), pharyngeal, and esophageal stages of swallowing.
Oral Prep Phase: food entering the mouth, chewing patterns with teeth, rotary chewing with the jaw, coordination of swallowing muscles, and strength of the tongue to move food to the teeth and the back of the mouth for the swallow.
Oral Transit Phase: food is thoroughly chewed and pushed together to the back of the mouth for swallowing. The soft palate closes to keep food from going up into the nasal passage for the swallow.
Pharyngeal Phase: food is brought to the pharynx (throat) and is swallowed. The epiglottis shuts, and the throat muscles prevent food or drink from entering the lungs and entering the esophagus.
Esophageal phase: after the food passes through the upper esophageal sphincter, peristalsis begins and moves the food through the digestive system to the lower esophageal sphincter. While a speech-language pathologist does not treat esophageal dysphagia, it can be identified through an instrumental swallowing test (MBSS).
Dysphagia is diagnosed through screenings or tests to evaluate the coordination and strength of the oral structures and the use of instrumental swallow evaluations. Instrumental evaluations are tests performed with medical instruments, such as FEES or MBSS, that allow the clinician to see how food or drink is consumed and swallowed.
With FEES (Fiberoptic Endoscopic Evaluation), a small camera on a tube is inserted into the nasal passage to look down over the vocal folds. From here, the clinician can observe the esophageal muscles and part of the oropharyngeal and pharyngeal phases of swallowing. This helps the clinician see if clients have a weak swallow, leaving food in the pharynx or allowing food or drink to move toward the lungs. Different consistencies of food and drink are given to ensure that different types of food or drink can be consumed safely.
MBSS (Modified Barium Swallow Study) is a test where a client sits in view of an X-ray machine and is given food and drink mixed with barium. The clinician can observe all phases of the swallow from a side view as the barium shows up on the machine. This helps the clinician see if clients have a weak swallow, difficulty moving food to the back of the mouth, leaving residue in the pharynx or contributing to acid reflux, or if they’re allowing food or drink to move toward the lungs. Different consistencies of food and drink are given to ensure that different types of food or drink can be consumed safely.
If you suspect you or a loved one may have dysarthria or a motor speech disorder, it is best to make an appointment with a speech language pathologist! The good news is that if dysarthria or a motor speech disorder is present, the speech therapists at Silver Linings Neurodevelopment can create customized treatment plans to help improve each patient’s unique challenges and ease their symptoms.
Treatment of dysphagia depends on an evaluation before therapy begins. This evaluation will determine what needs to be focused on to improve a client’s swallowing patterns and what kinds of swallowing therapy will benefit the client the best. Swallowing is a complex process with many moving parts, and initial tests will help determine which aspects of swallowing disorder need to be targeted to ensure the best treatment!
Treatment for swallowing problems is determined based on the difficulty someone is experiencing with swallowing. For example, if they are having oral difficulties, they may require exercises or strategies to assist in chewing or strengthening the tongue. This may not be recommended for those struggling with the pharyngeal phase of swallowing.
Ultimately, swallowing disorder treatment is given by a speech therapist, who recommends different swallowing exercises or compensatory strategies to improve swallowing and eating skills. Clinicians may also recommend changes in diet while swallowing skills improve to make eating safer!
It could be! Adults are very good at compensating for their difficulties with things like swallowing. Rather than identifying a physical swallowing problem, adults tend to avoid specific foods that are difficult to chew and swallow or drink after they take bites to help them swallow. Adults see avoiding foods or only eating softer foods as a simple change to their daily tasks. This avoidance can indicate swallowing difficulties that require addressing for adults to continue eating safely and no longer have to avoid specific foods.
Reach out to your primary care physician or your speech therapist! Before attending regular swallowing therapy sessions, you will likely be referred for a swallowing assessment (such as FEES or MBSS).
Once you attend an evaluation and a clinician is able to pinpoint which aspects of swallowing are difficult, then a clinician can create a treatment plan for you and your specific swallowing difficulties!