Dysphagia

What is dysphagia?

Dysphagia, pronounced ‘dis-fay-ja’, is a medical term used to describe difficulty with holding food in the mouth, chewing or swallowing. It can be a temporary or permanent condition and can occur at any age. Dysphagia can lead to several problems, the most serious of which is aspiration; when food, fluid or saliva enters the airway (lungs) leading to an increased risk of chest infections.

What causes dysphagia?

Dysphagia can be caused by many factors including:

• Stroke;
• Dementia;
• Neurological disease (e.g., Parkinson’s, Motor Neuron Disease, Multiple Sclerosis);
• Poor dentition (e.g., missing teeth or poorly fitting dentures);
• Structural/mechanical abnormalities (e.g., oesophageal webbing, cricopharyngeal bar);
• Poor general health; and
• Age.

What are the signs of dysphagia?

Dysphagia affects different people in different ways. Some people have mild symptoms, while for others it can be very distressing and difficult to eat and drink. This depends on the severity of dysphagia, which part/s of the swallow mechanism are affected and what is causing it. Signs of dysphagia include (McCarron, 2022):

• Coughing. This is a sign that food/fluids have entered the airway. Coughing is our body’s automatic response to material entering our lungs and attempting to expel it.
• Choking. This indicates that food is stuck in the airway. This may be a partial or complete blockage and should be acted on immediately.
• Frequent chest infections. When the material enters the lungs, it also carries the bacteria from your mouth. This combination can lead to recurrent chest infections and is a major sign that dysphagia may be occurring, even if a person is not displaying any outward signs during eating and drinking.
• Throat clearing during eating or drinking, or up to 30 minutes afterwards. This may indicate that there is food/fluid sitting above or on the vocal cords. This is dangerous as this residue could enter the lungs at any time.
• Moist-sounding voice or gurgly sounds in the throat. This is another sign that there is food or fluids sitting on the vocal cords.
• Shortness of breath or stopping breathing. When food or fluids enter the airway, it can be hard for someone to catch their breath. In extreme cases, they can stop breathing.
• Food sitting in the mouth or remaining pocketed in the cheeks after eating. This can be a sign that someone is unable to chew the food correctly or is not recognising the sensation of the food in their mouth. Food that remains undetected can create a choking risk later on.

• Sudden increase in body temperature after eating. Body temperature can be checked using a home thermometer approximately 30 minutes after drinking or eating. An increase in body temperature can indicate that food or fluids have entered the airway.
• Drooling. Drooling or food spilling from the mouth can indicate that someone has poor control of the muscles around the mouth. Oral strength and coordination are important for holding food in the mouth and building pressure to create a strong swallow.
• Dehydration/malnutrition. If someone is apprehensive to eat or drink, they may have developed a negative association with eating and drinking as a result of dysphagia (e.g., due to a sensation of choking). Having less food and water than normal can lead to dehydration and malnutrition.

What can a Speech Pathologist do for dysphagia?

Speech Pathologists are trained to diagnose, treat and manage dysphagia. Your Speech Pathologist will want to know everything you can tell them about when, where, why and how your dysphagia first started. They will take a detailed medical history and look for the causes of your dysphagia.

Your Speech Pathologist will then conduct an assessment with you before making recommendations for treatment and management.

Assessment. Your Speech Pathologist will ask you to complete some simple movement and speech tasks to find out if the muscles and nerves used for chewing and swallowing are working correctly.

The Speech Pathologist will then ask you to try a number of pre-prepared food and fluid consistencies to see how you manage them. If the Speech Pathologist has any further concerns, they may refer you to your GP to request a Videofluoroscopy Swallow Study (swallowing X-ray) so they can see what is happening internally.

Treatment and management. Based on your assessment results, the Speech Pathologist may prescribe changes to your diet and fluid consistency to make eating and drinking safer and more enjoyable for you. This prescribed diet is based on International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines.

The Speech Pathologist may also prescribe you positional/postural changes whilst eating and drinking to decrease your likelihood of aspirating on food/fluids. The Speech Pathologist will also schedule ongoing appointments for treatment and review based on your symptoms, severity and need for support.

If you present with severe dysphagia and are unable to consume any food or drink safely, a Speech Pathologist will refer you to your GP to speak to a specialist about your concerns. In severe cases, this may result in the insertion of Nasal Gastric (NG) tube or Percutaneous Endoscopic Gastrostomy (PEG) tube (Stroke Foundation, 2022).

When do I need to see a Speech Pathologist for dysphagia?

If you or someone you know is experiencing any signs of difficulty swallowing or chewing food, it is important that they see a Speech Pathologist as soon as possible.

You do not need a referral to see a private Speech Pathologist to assess your chewing and swallowing difficulties. In some cases, dysphagia can result in serious complications, such as aspiration pneumonia, which can be fatal if not managed correctly.

How can I increase safety during mealtimes?

If you or someone you know has dysphagia, you can decrease risk at mealtimes by implementing the following Safe Swallowing Strategies:

• Avoid distractions. Put away your phone, turn off the TV and make sure there is a quiet distraction-free environment when eating and drinking.
• Ensure you are alert and upright for all meals. Ensure that when you are eating and drinking that you are seated 90 degrees upright and are fully awake and alert.
• Take small bites of food and small sips of fluids. Take small bites/sips so that you can manage the mouthful easily before swallowing.
• Chew food well. Ensure that the food is chewed into small pieces prior to swallowing. This will reduce the risk of choking.
• Avoid talking when eating. Talking whilst eating is not only distracting, but it can also cause food/fluid in the mouth to accidentally be ‘breathed in’. This can result in choking or aspiration.
• Remain fully upright 30 minutes after mealtimes. If someone has food or drink still sitting in their mouth/throat, laying down directly after meals can make this material fall into the airway. Sitting upright for at least 30 minutes after meals can reduce the chance of this happening.
• Always check that meal and fluid consistencies are correct. If you or someone you are caring for is prescribed a modified diet or fluids, ensure that all foods are the correct consistencies, in line with the IDDSI guidelines. This information will be provided to you by your Speech Pathologist along with education on how to prepare and test consistencies.

If you, or someone you know has dysphagia and would like to book an initial consultation with a Speech Pathologist from our team, please contact us on 1300 086 280 or at [email protected].

References

McCarron, M. 2022. Eating, drinking & swallowing. [online]. MDN Australia. Available at: https://www.mndaustralia.org.au/mnd-connect/living-with-mnd/eating-drinking-swallowing

Stroke Foundation. 2022. Swallowing problems after stroke fact sheet. [online]. Stroke Foundation – Australia. Available at: https://strokefoundation.org.au/what-we-do/for-survivors-and-carers/stroke-resources-and-fact-sheets/swallowing-problems-after-stroke-fact-sheet