Apr 9, 2020
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Dysphagia: Causes and Treatment Plans

Dysphagia, or difficulty swallowing, affects up to 15 million adults in the United States and if not diagnosed and treated, can result in aspiration pneumonia, malnutrition, dehydration, weight loss, and breathing problems. Those who have had strokes, who have neurological conditions such as Parkinson’s disease, who have or had head and neck cancer, and the elderly are at the greatest risk for developing swallowing impairments. Possible signs of swallowing problems include mouth or facial weakness, recent weight loss, poor head control, coughing or choking when eating or drinking, weak cough or weak voice.

The process of swallowing involves more than 50 pairs of muscles and many nerves. There are three phases of swallowing. In the first phase, oral phase, food or liquid is manipulated and prepared to be swallowed. The food is chewed, mixed with saliva and formed into a cohesive unit, called a bolus. This process uses strength and coordination between the lips, tongue, jaw, and cheeks.

The second phase, pharyngeal phase, begins when the tongue pushes food or liquid to the back of the mouth and approaches two ‘tubes’ at the back of the throat (the esophagus – passageway to the stomach, and the trachea – airway). A small flap, called the epiglottis, closes at the top of the voice box to close off the opening to the trachea and prevent food or liquid from entering the lungs. In the last phase, esophageal phase, food or liquid passes from the top to the bottom of the esophagus. From the bottom of the esophagus, the food or liquid enters the stomach. Dysphagia can occur in any of these three phases.

There are widely used treatment techniques to manage oral and pharyngeal dysphagia used by Speech and Language Pathologists (SLPs). Treatments may involve one or a combination of techniques. Some of these treatment methods include exercises to strengthen the muscles damaged by impaired swallowing, compensatory strategies to decrease the risk of aspiration (such as chin tucks), and diet texture modification (thickened liquids, diet consistency alterations). For patients with severely impaired swallowing, a feeding tube and NPO status may be recommended to prevent the risk of aspiration pneumonia from occurring.

Dysphagia can be a debilitating medical condition. However, with timely diagnosis and proper treatment, quality of life can be greatly improved. Seeking treatment at the first sign of a swallowing impairment is very important and will result in the best treatment outcomes.

 

References:

  1. “Deciphering Dysphagia”, National Foundation of Swallowing Disorders, 2016.
  2. “Dysphagia: What is Dysphagia?”, https://www.consultant360.com/n411/home 2016