Swallowing Disorders

Swallowing is a complex process that allows food, liquid, saliva, and medication to move safely from the mouth through the throat and toward the stomach. It depends on coordinated movement of many muscles and nerves. When part of this process is disrupted, a person may experience a swallowing disorder, also called dysphagia.

Swallowing difficulties can affect people of any age and may range from mild problems with certain foods to more significant difficulty eating or drinking safely. A Speech-Language Pathologist can assess swallowing function and help determine appropriate management or swallowing therapy. Speech-language pathologists provide assessment and intervention for feeding and swallowing disorders across the lifespan.

Signs of a Swallowing Disorder

A person experiencing dysphagia may:

Cough or choke while eating or drinking
Have trouble swallowing food, liquid, or pills
Feel that food is stuck in the throat or chest
Need multiple swallows for one bite or sip
Have food or liquid come back into the mouth or nose
Take much longer than usual to eat
Avoid certain foods because they are difficult to swallow
Experience a wet or gurgly voice after swallowing
Have difficulty controlling food in the mouth
Experience pain or discomfort when swallowing
Have recurring respiratory concerns associated with eating or drinking

Food or liquid may sometimes enter the airway instead of travelling safely toward the stomach. This is called aspiration. Aspiration can increase the risk of respiratory complications, including aspiration pneumonia, although some people may aspirate without obvious coughing or choking.

Types of Dysphagia

Swallowing problems can occur at different stages of the swallowing process.

Oral dysphagia involves difficulty preparing or moving food or liquid through the mouth.

Oropharyngeal dysphagia involves difficulty moving food or liquid from the mouth through the throat. This type of swallowing difficulty is commonly addressed by Speech-Language Pathologists.

Esophageal dysphagia involves difficulty moving food through the esophagus toward the stomach. People may describe food as feeling stuck in the throat or chest. Esophageal swallowing problems may require medical assessment by a physician, gastroenterologist, or other appropriate specialist.

What Causes Swallowing Difficulties?

Dysphagia may result from conditions affecting the brain, nervous system, muscles, throat, or esophagus. Possible causes include:

Stroke
Brain injury or traumatic brain injury
Parkinson’s disease
Multiple sclerosis
Amyotrophic lateral sclerosis (ALS)
Cerebral palsy
Muscular dystrophy
Other neurological conditions
Head and neck cancer
Head and neck surgery
Muscle weakness
Structural changes or scar tissue involving the throat or esophagus

Some esophageal swallowing problems may also be associated with gastroesophageal reflux disease (GERD), eosinophilic esophagitis, narrowing of the esophagus, or other medical conditions. The underlying cause is important because swallowing treatment varies considerably depending on the type of dysphagia and the person’s overall health.

Swallowing Assessment

A Speech-Language Pathologist may assess how safely and efficiently a person eats and drinks. Assessment can include a health and swallowing history, examination of the mouth and oral movements, observation while eating or drinking, and evaluation of signs that may suggest difficulty controlling or swallowing food and liquid.

When additional information is required, an instrumental swallowing assessment may be recommended. Examples include a modified barium swallow, also known as a videofluoroscopic swallowing study, or a fiberoptic endoscopic evaluation of swallowing (FEES). These assessments provide additional information about what happens during the swallowing process and can help guide an individualized therapy plan.

Swallowing Therapy and Dysphagia Treatment

Swallowing therapy is individualized according to the person’s diagnosis, abilities, goals, and assessment findings. Treatment may include:

Swallowing exercises when clinically appropriate
Strategies to support safer eating and drinking
Changes to positioning or pacing
Techniques to improve control of food or liquid
Recommendations regarding food texture or liquid consistency when indicated
Education for the individual and family members
Coordination with physicians and other healthcare professionals

The goal of dysphagia treatment is to support safe, efficient swallowing and help the person participate in eating and drinking as successfully as possible.

At S.L. Hunter SpeechWorks, Speech-Language Pathologists assess and treat a variety of swallowing difficulties. Contact the clinic to learn more about swallowing assessment, swallowing therapy, dysphagia treatment, and current service availability.

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