What is dysphagia?

Dysphagia is a difficulty with swallowing; this can occur at any phase of the swallow. The swallow has 4 phases: oral prep, oral transit, pharyngeal, and esophageal. There are three main types of dysphagia: 

1. Oral dysphagia occurs when someone presents with difficulty chewing and/or transporting food to the throat. 
2. Oropharyngeal dysphagia occurs when a person presents with difficulty initiating the swallow and clearing out the bolus. 
3. Esophageal dysphagia occurs when a person presents with difficulty passing food through the esophagus and into the stomach (treated often by gastroenterologist).

Speech Language Pathologists (SLP) at Silver Liningscan assess, diagnose, and treat oral and oropharyngeal dysphagia.

Coughing while eating or drinking

Food residue remains on the tongue and/or in the mouth

Wet vocal quality during and after eating and/or drinking

Food and drink spilling out of the nose, mouth, and/or lips

Constant throat clearing while eating or drinking

Shortness of breath during chewing or swallowing

Prolonged and/or uncoordinated chewing

Aspiration is when food, saliva, liquid, and/or anything else enters the airway. Aspiration can develop into a serious condition called aspiration pneumonia. Everyone aspirates from time to time, but consistent aspiration puts individuals at a higher risk for aspiration pneumonia.

Dysphagia can be assessed by a SLP through two different instrumental examinations, MBSS and FEES. Prior to undergoing an MBSS or FEES, you will likely participate in a clinical swallow evaluation (CSE). During the CSE you will be presented with different types of food and liquids to eat and drink. If the SLP notices any signs and symptoms of aspiration, they will refer you for an instrumental. Instrumental evaluations are key to properly assessing and treating dysphagia.

MBSS

MBSS or Modified Barium Swallow Study is an X-ray procedure performed by a SLP in conjunction with a radiologist. During this evaluation you will be presented with different types of food and drink containing barium. The barium allows for the different food and drink presentations to be seen on the X- ray. This allows the SLP to confirm the presence of aspiration, what foods and drinks are being aspirated on, and if there are any strategies that reduce the presence of aspiration.

FEES

FEES or Flexible Endoscopic Evaluation of Swallowing is a procedure performed by a SLP or other medical professionals to assess motor and sensory function of the pharyngeal and laryngeal structures during swallowing. During this procedure an endoscope with a camera on the end is passed through the nose and into the throat to allow visualization of the anatomical structures. This procedure allows the SLP to assess and visualize the presence and amount of aspiration occurring at which food consistencies and viscosities.

Dysphagia can be treated with two different approaches: restorative and compensatory. 

• Restorative approaches include swallowing strength exercises. The best way to improve the swallow is to swallow. 
• Compensatory strategies include thickened liquids, modified diets, and/or posture changes.

More information on dysphagia may be found HERE!

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Megan Zecher, CCC-SLP
Speech Language Pathologist