Dysphagia, or difficulty swallowing, can manifest at various stages of the swallowing process and can be caused by a range of factors. If you are experiencing difficulty swallowing, it is important to understand the intricacies of dysphagia and available treatment options. Whether you're seeking to understand dysphagia for personal knowledge or are looking for guidance on managing the condition, this guide aims to provide you with valuable insights and practical information. Embark on this journey to enhance your understanding of dysphagia and its impact on individuals' well-being with the medical experts at Methodist Le Bonheur Healthcare.

What is Dysphagia?

Most of us have experienced coughing during a meal and telling concerned onlookers, "It's okay. It just went down the wrong tube." While sporadic coughing during meals is normal, frequent coughing or coughing during most meals can indicate a more serious issue. Dysphagia is a medical term that refers to difficulty swallowing. Difficulties can occur at each stage of the swallowing process: oral phase (mouth), pharyngeal phase (throat), and esophageal phase.

Exploring the Different Stages of the Swallowing Process

Oral phase: Preparing Food for Swallowing

During this phase, your lips, jaw, teeth and tongue work to prepare the food or liquid for swallowing (e.g., sucking, chewing, and moving the food around the mouth). After the food or liquid has been adequately prepared, the material is formed into a small, rounded mass that the tongue then propels backward into the throat.

Pharyngeal phase: Safely Directing Food to the Esophagus

As the food enters your throat, your airway closes off to prevent food and drink from entering your lungs. Food or liquid entering the airway can cause coughing and choking. The food is squeezed toward your esophagus.

Esophageal phase: Passage to the Stomach

The esophagus, which opens during the swallow, is a tube through which food passes to the stomach. Food can become stuck or lodged in the esophagus, which can be uncomfortable. Other issues that can occur are vomiting or acid reflux (stomach acid that backs up into your esophagus and causes a burning sensation).

What Are Some Signs and Symptoms of Dysphagia?

While not an exhaustive list, the following behaviors may indicate a swallowing problem: 

• Difficulty swallowing food, liquid, or pills.
• Feeling that food is stuck in the throat or chest.
• Coughing or choking during or after eating or drinking.
• Regurgitation of food or liquid.
• Pain or discomfort in the chest or throat while swallowing.
• Unexplained weight loss or malnutrition.
• Frequent respiratory infections or pneumonia, especially in older adults.
• Gurgling or wet vocal quality during or after swallowing.
• Taking longer to eat or drink or needing to pause or take multiple swallows during meals.
• Avoidance of certain foods or liquids due to difficulty swallowing.

Swallowing problems can lead to dehydration, malnutrition, food or liquid entering the airway (aspiration), respiratory issues (e.g., pneumonia), and reflux. These symptoms can be progressive, meaning they can get worse over time, or have a sudden onset. Other medical conditions may also cause these symptoms, so it's important to consult a healthcare professional for proper diagnosis and treatment.

What Causes Dysphagia?

Dysphagia can be caused by neurological issues or deficits to the head, neck, or mouth. The following list includes some but not all of the conditions that can cause dysphagia:

• Stroke
• Brain injury or spinal cord injury
• Head and neck cancer
• Parkinson's disease, Alzheimer's disease, and other neurological conditions
• Conditions that cause muscular weakness, such as muscular dystrophy, cerebral palsy and ALS
• Conditions or medications that lead to less saliva
• Bad teeth, missing teeth, or ill-fitting dentures

How is Dysphagia Diagnosed?

If you have trouble swallowing, it is crucial to contact your primary care physician (PCP). Depending on the root cause of your dysphagia, your PCP may refer you to a gastrointestinal physician, a neurologist, an ear, nose, and throat (ENT) specialist, or a dentist. While these physicians can help address the underlying cause of your swallowing disorder, a speech-language pathologist (SLP) is trained in managing dysphagia and can offer services that include evaluation, diagnosis, and rehabilitation. To see an SLP, you will need a referral from your PCP or any physician assisting in your medical care.

As part of your evaluation, the SLP will:

• Inquire about your health, past illnesses, surgeries, and swallowing problems
• Observe how the muscles of your face, mouth, and neck move
• Watch how you eat, including your positioning, how you feed yourself, and what happens when you swallow
• Perform special tests, if needed

To better understand the nature of your swallowing disorder, the SLP will need to assess how the muscles used during swallowing work. This can be done in two ways:

Modified Barium Swallow Study (MBSS)

This test is performed in the radiology department of a hospital using a video X-ray. You will sit in a chair and eat or drink food or liquid with barium in it. This barium allows the food and liquid to show up on an X-ray so the SLP can watch where the food goes and how the muscles in your mouth, throat, and esophagus move.

Flexible Endoscopic Evaluation of Swallowing (FEES)

For this test, the SLP puts a small tube with a light on the end of it into your nose and down into your throat. This tube has a camera, and the SLP can watch you swallow on a screen. This study is unique because it allows the SLP to look directly at your vocal folds or voice box. 

What are my Treatment Options? 

Treatment for dysphagia depends on the underlying cause and severity of the condition. In some cases, dysphagia may improve on its own or with simple interventions, while in other cases, more extensive treatment may be necessary. Some common treatment options for dysphagia include:

Swallowing Therapy: Strengthening Muscles and Developing Strategies

This type of therapy focuses on improving the strength and coordination of the muscles used for swallowing. A speech-language pathologist (SLP) can provide this type of therapy, which may involve exercises to strengthen the muscles of the mouth and throat, as well as provide strategies for positioning the body and food during meals to make swallowing easier.

Dietary Modifications: Adapting the Diet for Easier Swallowing

Certain changes to a person's diet can make swallowing easier and reduce the risk of choking or aspiration. This may include eating softer foods or foods that are easier to chew and swallow and avoiding certain foods that are more difficult to swallow, such as dry or tough meats. Liquids may also need to be thickened, which causes the liquid to move more slowly through the throat and give the airway more time to close. This can prevent aspiration from occurring.

Medications: Manage Underlying Problems

In some cases, medications may be prescribed to treat the underlying condition causing dysphagia. For example, if dysphagia is caused by GERD, medications to reduce acid production in the stomach may be prescribed.

Surgery: Correcting Structural Issues to Restore Swallowing Function

In some cases, dysphagia may be caused by a structural problem that requires surgical intervention. For example, if dysphagia is caused by a blockage in the esophagus, surgery may be necessary to remove the blockage.

Feeding tubes: Ensuring Adequate Nutrition and Hydration

In severe cases of dysphagia, a feeding tube may be necessary to ensure adequate nutrition and hydration. Feeding tubes can be temporary or permanent and inserted through the nose or mouth or directly into the stomach or intestines.

Where Can I Seek Treatment?

The speech-language pathologists at Methodist South Outpatient Rehab specialize in swallowing therapy. Their goal is to help those in Whitehaven and the greater Memphis area improve their swallowing function through evidence-based, high-quality treatments. The SLPs have received advanced training to evaluate, diagnose, and treat swallowing disorders. They provide onsite evaluations, including instrumental assessments such as MBSS.

They are located at 1251 Wesley Drive, Suite 141, Memphis, TN 38116. If you have questions, call them at (901) 516-3726. Physicians can fax referrals/orders to them at (901) 516-3055.