What are swallowing disorders (also called dysphagia)?

A swallowing disorder is when there is a problem with getting food and drink safely and efficiently from the mouth down through the throat and esophagus into the stomach.

Swallowing is a complicated process that involves many different muscles, structures and nerves. With so many factors at play, there are several different ways that something can go wrong and lead to a swallowing disorder.

Swallowing disorders can be due to motor (movement) problems, sensory problems, or a mixture of these.

What are signs/symptoms of swallowing disorders (dysphagia)?

Some signs and symptoms of swallowing disorders include:

  • Coughing and/or choking while eating
  • Each sip or bite takes many swallows to clear
  • Feeling of food “sticking” in your mouth or throat
  • Pain during swallowing
  • Unexpected weight loss
  • Food or drink coming out through your nose when eating/drinking
  • Regurgitation of food or drink back up into your throat or mouth

What causes swallowing disorders (dysphagia)?

Swallowing disorders can be due to various reasons, including:

  • Neurological disorders (for example: Multiple Sclerosis, Parkinson’s Disease, ALS)
  • Nerve damage (for example: stroke, brain or spinal cord injury)
  • Cancer (due to the tumour or due to cancer treatments, including surgery and/or chemoradiation)
  • Esophageal disorders (for example: acid reflux disorder, reduced esophageal motility/peristalsis)

How common are swallowing disorders (dysphagia)?

Approximately 1 in 6 adults in the United States will experience a swallowing disorder in their lifetime.1

When individuals struggle with swallowing disorders, there can be a large negative impact on quality of life. Swallowing disorders can reduce people’s ability to eat the food they once loved and they may not feel comfortable going out to eat with their friends and family.

Did You Know? – **Swallowing disorders can occur at any age, from newborn babies to elderly grandparents.**

How do you assess a swallowing disorder (dysphagia)?

  • Chairside assessment: this is when a speech-language pathologist (SLP) gives you something to eat or drink and watches as you chew and swallow. The SLP might gently place their fingertips on your throat while you swallow, or might look in your mouth afterwards to see if there is any food left. There are some things that an SLP can note during a chairside assessment, including whether you coughed while eating and how long it took for you to chew. However, SLPs (unfortunately) do not have x-ray vision and cannot see what is happening inside your throat when you swallow.
  • Videofluoroscopic swallow study (VFSS): this is an x-ray video of your head and neck while you eat and drink various foods mixed with barium. Barium is a white contrast that looks dark on the x-ray video allowing your SLP to see the food and drink during the exam. The SLP and radiologist can use this video to determine which food consistencies and volumes are safe for you to eat. Most importantly, they will look at how the swallowing structures are moving and WHY the swallow is going wrong, creating the swallowing disorder. All this information is then used to provide you with management recommendations and to plan your therapy with targeted exercises.
  • Fiberoptic Endoscopic Evaluation of Swallowing (FEES): this is when a doctor or SLP places a flexible scope with a camera into your nose to look down into your throat as you swallow. Similar to the VFSS (above), they can see if there is food left in the throat and whether things are “going down the wrong tube“. As with the VFSS, they can see how various swallowing structures are moving and WHY the swallow is going wrong. Unlike the VFSS, this assessment method does not involve the use of x-ray.
  • Esophageal tests: If the swallowing disorder is due to a problem with the esophagus (the muscular tube that takes food down to your stomach), various tests can be completed to confirm this. These tests include a barium esophagram, esophageal manometry, or pH testing.
  • Patient-reported measures: You may be asked to fill out questionnaires asking you how your swallowing disorder is affecting your function and your quality of life. You are an important member of the team in treating your swallowing disorder, so your perspective and priorities are very important.

How do you treat swallowing disorders (dysphagia)?

The treatment for swallowing disorders should be based on the problems that were seen during the assessment. Not every treatment is appropriate for every problem, so it is important to know the target of the therapy. For example, if the issue causing the swallowing disorder is an esophageal stricture (a narrowing in the tube going down to your stomach), then this would be more appropriately treated with a medical procedure with a doctor rather than swallowing exercises.

Depending on the cause, swallowing disorders may be treatable with various swallowing exercise programs. Some exercises involve swallowing really hard, or pausing mid-swallow and squeezing all of your muscles. Your SLP will guide you as to which exercises or treatments are the most appropriate for you.

The aim of swallowing exercises is to strengthen the muscles and improve range of motion and coordination of structures used for swallowing. The end goal is to make the swallow more efficient and safe.

Your SLP will help to determine how many reps, sets, and sessions of exercises you should complete in a day in order to improve your swallowing function. Just like a personal trainer at the gym!

Blocks of swallowing therapy often involve sessions with your SLP, as well as performing daily home practice. This home practice is essential to ensuring that you see gains from your swallowing therapy.

When planning your treatment for your swallowing disorder, your SLP will ask you what goals you would like to achieve through therapy. Maybe you would like to eat your favourite pasta dish again, or maybe you would like to be able to not have to spend an hour at the dinner table because it takes you so long to swallow your food. Through swallowing therapy, you will work towards improving your ability to eat so that you can enjoy the life you’re living.

About the Author

Shannon Kerr, BMus, MHSc, R.SLP, SLP-(C)

Speech-Language Pathologist

To learn more about rehabilitation exercises for swallowing disorders, visit our post here.

About Mobili-T: Mobili-T is the innovative wireless sEMG biofeedback device that helps you live well with dysphagia.

References

  1. Adkins, C., Takakura, W., Spiegel, B. M. R., Lu, M., Vera-Llonch, M., Williams, J., & Almario, C. V. (2020). Prevalence and Characteristics of Dysphagia Based on a Population-Based Survey. Clinical Gastroenterology and Hepatology, 18(9), 1970-1979. pubmed.ncbi.nlm.nih.gov/31669055/
  2. Burkhead Morgan, L. Exercise-based dysphagia rehabilitation: past, present, and future. (2017). Perspectives of the ASHA Special Interest Groups, 2(1), 36-43. doi.org/10.1044/persp2.SIG13.36
  3. Humbert, I.A., & German, R.Z. (2013). New directions for understanding neural control in swallowing: the potential and promise of motor learning. Dysphagia, 28, 1-10. pubmed.ncbi.nlm.nih.gov/23192633/
  4. Langmore, S. E., & Krisciunas, G. P. (2010). Dysphagia after radiotherapy for head and neck cancer: etiology, clinical presentation, and efficacy of current treatments. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 19(2), 32-38. doi.org/10.1044/sasd19.2.32
  5. Martino, R., Foley, N., Bhogal, S., Diamant, N., Speechley, M., & Teasell, R. (2005). Dysphagia after stroke. Stroke, 36(12), 2756-2763. pubmed.ncbi.nlm.nih.gov/16269630/
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