DYSPHAGIA (SWALLOWING DIFFICULTIES)

Swallowing and eating is not only important to our survival but also to our sense of connection, social identity, and social involvement with others.

You may have never thought about how complex swallowing is, or how important it is to your daily interactions with others, until you experience difficulties or discomfort with eating. Difficulties with eating including difficulties in the oral cavity (mouth), pharynx, esophagus (tube in which transfers food into stomach) or gastroesophageal junction (the location where food enters the stomach) is known as dysphagia and can be a result of several different medical conditions, including structural changes or differences in your body, stroke, traumatic brain injury or a neurological condition.

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If you have dysphagia, you may be experiencing one or more of the following symptoms:

• Difficulty keeping food or liquid in your mouth, food leaks out of the mouth due to poor lip closure

• Difficulty managing the food in your oral cavity and drooling

• A feeling that food is “sticking” somewhere in your mouth or throat

• A sensation of a lump in your throat or fullness in your neck

• Pain when swallowing

• Coughing either during or immediately after eating or drinking

• Food or liquid coming out of the nasal cavity

• You take an extended length of time and effort to chew or swallow

• Difficulty breathing when swallowing (coordination of breathing and swallow may be impaired)

• A change in your voice quality to wet or gurgly sounding during or after eating or drinking,

• Frequent visits to your doctor or local hospital for recurrent fever, respiratory infection, or aspiration pneumonia

• Avoidance eating foods that you once enjoyed 

• Loss of weight or appetite

You may also experience a loss of interest in eating and overall enjoyment with eating or drinking due to either embarrassment or feelings as though others are noticing your differences when eating.

What does a dysphagia assessment look like?

Non-instrumental assessment: In order to assess your swallowing difficulties, we will watch for signs and symptoms of dysphagia while you are eating. We will also take into consideration other factors that may be influencing your swallowing difficulties such as fatigue when eating, how you are positioned when eating, and other environmental conditions. We will observe speech and vocal quality before, during, and after the swallow, as well as changes in heart rate, facial appearance, and physiological status. 

Case history: We will gather detailed information about your medical conditions and consult caregivers and other health professionals involved.

Oral mechanism exam: We will ask you to move your mouth, jaw, lips, and tongue in different ways in order to observe your strength, tone, range of motion, and ability to coordinate movement. In addition, we will look inside your mouth and at the structure of your face, lips, tongue, and jaw. We may conduct a cranial nerve assessment to determine whether there is an underlying neurological impairment. We will also assess compensatory strategies or changes to food delivery to determine whether certain strategies or changes to food worsen or improve swallowing.

Following the assessment, you may be referred for a swallow study to further investigate the nature of your swallowing impairment or difficulties.

What does dysphagia therapy look like?

The most important goal for swallowing intervention is to ensure that you are able to safely and efficiently manage both solids and liquids in order to support hydration and nutrition. Often consultation with your doctor(s) and other health practitioners (e.g., occupational therapist, GI specialist, dietician) is critical in moving forward as it will help to guide treatment decisions such as diet modifications, the use of compensatory strategies or exercises. Dysphagia therapy can involve compensatory strategies that change the swallow, exercises to improve certain functions of the swallow, and changes to diet consistency.