Dysphagia

/Dis-fay-jah/

noun: Difficulty or discomfort swallowing

What is Dysphagia?

Dysphagia refers to difficulty or discomfort swallowing. Dysphagia affects between 15 and 18 million people in the USA, and an estimated 1 in 17 people will experience swallowing difficulties during their lifetime.

Swallowing impairments often profoundly impact quality of life; from causing embarrassment during social situations involving food, to depression, to significant health risks including weight loss and need for tube feeding, aspiration pneumonia, and even (if untreated) asphyxiation and death.

One study found that 78% of skilled nursing re-hospitalizations were due to preventable impairments that can be affected by dysphagia and diet/liquid modifications (congestive heart failure, respiratory infections, urinary tract infections, and electrolyte imbalance). One common infection caused by dysphagia, aspiration pneumonia, is itself the 5th leading cause of death for people over 65 in the United States (3rd leading cause in people over 85). Accurate dysphagia diagnosis and management can greatly reduce the risk of aspiration pneumonia and re-hospitalizations.

Causes of Dysphagia

There are many things that can cause dysphagia, including damage to the muscles, nerves, or structures of the mouth and throat. Some factors that can lead to an increased risk include (but are not limited to):

Stroke
Surgery
Intubation
Respiratory failure
Tracheotomy and ventilator dependency
COPD
Head and neck cancer
Radiation treatment
Neurological conditions (e.g. MS, Parkinson's)
Dementia
Traumatic injuries including TBI
Birth defects of the swallowing tract
Premature birth
Cleft lip & palate
Normal aging

Symptoms of Dysphagia

Dysphagia affects everyone differently. It may not be readily apparent early on because people compensate by avoiding certain foods or drinking fluids less. Some common signs and symptoms of dysphagia to look for include:

Coughing, choking, or pain while swallowing
Throat clearing
Difficulty taking medications
Feeling of something "stuck" in the throat
Holding food in the mouth
Loss of food or liquids from the mouth
Nasal regurgitation
Having to cut food up into smaller pieces
Avoiding foods that are hard to swallow
Dehydration
Unintended weight loss or decreased appetite
Shortness of breath
Pneumonia
Reflux.

What is Aspiration?

Aspiration occurs when a "foreign body" (food, liquids, saliva, or pills) enters the airway. This can happen as a result of swallowing muscle weakness, poor neural control, decreased alertness, sedation, and other reasons. Many people experience aspiration as something "getting struck" or "going down the wrong way" while swallowing which can cause coughing and choking. However, around 50% of all aspiration is silent, meaning there are no visible signs that it is occurring. This is why it is so important to have tools that can see inside the throat to tell if aspiration is actually happening, and how to prevent it. If untreated, aspiration can lead to a serious medical condition called aspiration pneumonia.

Aspiration pneumonia can be fatal, and was the third leading cause of death in skilled nursing facilities in 2017. Some signs and symptoms of pneumonia include: fever, chronic cough, wheezing, shortness of breath, and abnormal chest x-ray, along with signs of dysphagia. If aspiration pneumonia is suspected, patients should seek medical attention immediately and a swallow consultation should be ordered by a speech-language pathologist (SLP). FEES is a tool designed specifically to look at the swallow from the inside in order to see how best to treat dysphagia and prevent aspiration. What is FEES?>>

Aspiratin anchor

Dysphagia Diagnosis & Treatment

When dysphagia is suspected, the patient is referred to a speech-language pathologist (SLP) who evaluates them to learn more about the nature of the problem. Their assessment includes reviewing medical history, asking questions about symptoms, and seeing the patient swallow different foods and liquids. They may also order an instrumental examination including endoscopy or video x-ray (FEES or MBS) to see what is going on in the throat and esophagus. From there, they may consult additional specialists (e.g. GI doctor, ENT) and devise a treatment plan.

Dysphagia can be treated through conventional speech therapy including education, exercises to strengthen the muscles involved in swallowing, strategies to lessen symptoms (e.g. tucking the chin while drinking), and/or diet modifications. This includes altering food textures and temperatures or thickening liquids to improve sensation and trigger a more timely swallow. When dysphagia is severe, a patient may be placed NPO (Latin for "nothing by mouth") for a time and receive nutrition through feeding a tube. This method is not ideal, as it leads to decreased quality of life, is costly and invasive, and often caries additional risks of infection. Keeping the mouth clean and focusing on rehabilitating the swallow should be priorities to decrease the risk of aspiration pneumonia.