Dysphagia is a medical term for swallowing disorder. It encompasses any problem with sucking, swallowing, drinking, chewing, eating, controlling saliva, taking medication or the ability to protect your airway from food or fluids going into the lungs. It can also be an issue with any foods/fluids falling out of the mouth or dibbling due to difficulty in keeping lips closed. Dysphagia is usually known to affect adults more than children (Bhattacharyya, 2014).

Some studies have reported that incidence of dysphagia in adults over 50 years of age is 22% (Lindgren & Janzon, 1991; National Foundation of Swallowing Disorders, n.d.; Tibbling & Gustafsson, 1991). It is even more prevalent in the elderly population who are admitted to hospitals. Dysphagia is usually the symptom of another medical illness. It can cause weight loss, malnutrition, dehydration and aspiration pneumonia.

Dysphagia can have significant impacts of your daily life; such as restricting lunches with your friends or limiting what foods you can enjoy (Nund et al. 2014). Speech Language Pathologists (SLP) are not only trained to assist with communication difficulties, but also swallowing disorders. SLP’s can assist in the diagnosis and management of swallowing disorders through evidenced based assessments and treatments.

Causes

Dysphagia is commonly caused by reflux (also known as Gastroesophageal reflux) neurological injury, structural abnormalities or disorders of the lungs (Martino and colleagues, 2005; Flowers, Silver, Fang, Rochon, & Martino, 2013). Other causes also include, age-related decline and injuries from surgeries or radiation therapy.

Reflux

This is when stomach acid flows back up the oesophagus or food pipe.

Neurological Disorders

Illness of the nervous system and brain can cause dysphagia, these include:

Structural Abnormalities

The structure of face, head or neck can affect the swallow function. This can include cleft palate, birth defects and any other injuries that may have altered the structures.

Signs and Symptoms

The following are the signs and symptoms which may indicate that you have dysphagia:

  • Food or fluid getting stuck in your throat
  • Increased coughing or throat clearing around mealtimes
  • Discomfort or choking while eating/drinking
  • Shortness of breath during mealtimes
  • Avoiding certain textures or foods because they are hard to swallow
  • Frequent chest infections, which means that food and fluids are going into your lungs. This is also known as aspiration.

Assessment

Speech-Language Pathologists are trained to diagnose and treat dysphagia. Nurses in hospitals are also able to do screening assessments to decide if a patient is at risk of aspiration. In which case they would refer to SLP for a full swallow examination.

Two different types of assessment methods are used to diagnose dysphagia:

  • Clinical Swallow Examination
  • Instrumental assessments

Clinical Swallow Examination

This examination is conducted by a SLP. They may ask you questions regarding your medical background and questions related to swallowing to understand the issue. Then an oro-motor assessment will be completed which tests how well the muscles or the face and neck are functioning. Finally, the SLP will do food and fluid trials, in which they will ask you to drink some fluids of different consistencies and eat different types of foods to directly assess your swallow.

Instrumental Assessments

During the clinical swallow examination, if the SLP finds as issue with your swallow, but is unable to determine the cause of it, then further advanced testing will be required. The following tests are the most common and evidenced-based assessments for dysphagia:

  • Videofluroscopic Swallowing study (VSS)
  • Fiberoptic Endoscopic Evaluation of swallowing (FEES)

These tests are done with a radiologist and will provide a better view of your swallow, which assists in accurately determining the cause of dysphagia.

Treatment

Once it has been determined that you have a swallowing disorder, the SLP will provide some strategies and recommendations in regards to your diet. Depending on the problem with your swallow, the SLP may recommend changes to the consistencies of your food and fluid.

For example, you may be recommended to have thicker fluid consistencies, such as honey, as you may struggling to drink water which is a thinner consistency.

For food, you may need to have softer consistencies as eating hard and chewy foods will worsen your swallowing function. Foods and fluids of different consistencies have been classified under certain levels by the International Dysphagia Diet Standardisation Initiative. More information about these levels of consistencies can be found on their website: https://iddsi.org/

SLP can also provide strategies and techniques based on evidenced-based practice. These are external techniques that do not change the consistency of the food/fluid to assist with swallow but may instead change the way you eat and drink. For example, a certain posture is recommended when eating or using smaller spoon instead of a bigger spoon or using a straw when drinking.  The SLP will provide education on how to implement the recommended strategies and techniques to minimise any swallowing problems and risk of aspiration.

Dysphagia is a swallowing disorder that affects how you chew food, drink, take medications and protect your airway. Dysphagia can affect people of all ages, but it is commonly known to affect people over 50 years. This is due to dysphagia being a symptom of another medical illness. It can also affect your quality of life by restricting participation in mealtimes. SLP can diagnose and treat dysphagia using evidenced-based practice. An individualised treatment plan can be made by an SLP which can include changes to consistencies of food or drinks, or strategies and techniques to improve your swallowing function. Dysphagia can have many negative consequences, such as aspiration pneumonia which can be fatal. 

General Strategies for safe swallowing

Even if you are not suffering from a swallowing problem, it is important to still implement safe swallowing strategies to prevent any issues in the future.

  • Stay upright/seated position when eating
  • Eat slowly, and make sure to chew the food properly before swallowing
  • Avoid talking while eating
  • Take small bites of food
  • Following a meal, stay seated in an upright position for at least 30 minutes to 45 minutes.

What to do now?

If you or someone you know is struggling to eat and drink, give us a call at Generation Physio & Allied Health, we have a friendly team of professionals that are dedicated to changing the lives of our clients. All of our clinicians are mobile and come to your own home to conduct an examination. Give us a call on 1300 122 884 to book a consultation today.


Article Written By Tulika Guha
Speech Pathologist – Brisbane and Gold Coast

Tulika graduated from University of Queensland with a Bachelor of Speech Pathology (Honours) and was also awarded First Class Honours. Tulika has lived in various towns and cities across Australia and hence has been exposed to different types of communities. Tulika was born in India and is trilingual in Bengali, Hindi and English.

She has previously worked as a Speech Language Pathologist at a private practice in Gold Coast. Her caseload included clients from the ages of 3 to 85 years, hence she has provided services to a variety of clients with many presentations.

She has experience working with children with Autism, global developmental delay, literacy delay, intellectual disability. She has also provided therapy to adults with cerebral palsy, dysphagia, Traumatic brain injury and down syndrome.

Learn More about Tulika Here


References

Bhattacharyya, N. (2014). The prevalence of dysphagia among adults in the United States. Otolaryngology–Head and Neck Surgery, 151, 765–769.

Flowers, H. L., Silver, F. L., Fang, J., Rochon, E., & Martino, R. (2013). The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. Journal of Communication Disorders, 46, 238–248.

Lindgren, S., & Janzon, L. (1991). Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia, 6, 187–192.

Martino, R ., Foley, N.,Bhogal, S.,Diamant, N., Speechley, M., & Teasell, R. (2005). Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke, 36, 2756–2763.

National Foundation of Swallowing Disorders. (n.d.). Swallowing disorder basics. Retrieved from http://swallowingdisorderfoundation.com/about/swallowing-disorder-basics/

Nund, R. L., Scarinci, N. A., Cartmill, B., Ward E. C., Kuipers, P., & Porceddu S. V. (2014). Application of the International Classification of Functioning, Disability and Health (ICF) to people with dysphagia following non-surgical head and neck cancer management. Dysphagia, 29: 692-703.

Tibbling, L., & Gustafsson, B. (1991). Dysphagia and its consequences in the elderly. Dysphagia, 6, 200–202.

 

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