Dysphagia and Feeding Problems
What is dysphagia? Is it a disease?
Dysphagia is not a disease. It is a set of symptoms that affects how well you can swallow. Swallowing involves the skilled coordination of several nerves and 26 different muscles in the neck and esophagus.
I've never heard of swallowing problems before. How common are they?
Research has revealed some interesting facts about dysphagia:
- More than 10% of all patients admitted to a general hospital had swallowing disorders.
- In acute care hospitals, almost 30% of patients recovering from a stroke had dysphagia.
- In one recent study at a physical rehabilitation hospital, dysphagia was found in three out of four adults recovering from a brain injury and more than half of the adult stroke patients.
Is there more than one type of dysphagia?
There are several major classifications of dysphagia.
- Oral preparatory dysphagia is characterized by difficulty in taking food, chewing it into small bits, mixing it with saliva, and forming it into a bolus.
- Oral phase dysphagia occurs when it is difficult to control the bolus of food and transporting it to the back of the mouth.
- Pharyngeal phase dysphagia occurs when swallowing becomes difficult when the food is at the top of the pharynx (throat area) and at the very back portion of the mouth.
- Esophageal phase dysphagia is characterized by swallowing difficulties when the food has entered the esophagus (passageway to the stomach).
Are all dysphagia swallowing disorders treated the same way?
No. In fact, some clients who have the same classification of dysphagia may not be treated the same way. The severity of their dysphagia is one factor that helps determine the treatment approach.
Dysphagia Red Flag Warning Signs
- Frequent or inconsistent episodes of coughing and choking on food and sputum.
- Excessive drooling.
- Unexplained weight loss.
- Dysarthric speech - slow, labored articulation; nasal air emissions; hoarse, breathy voice; low volume aphonic.
- Confused mental state.
- Absent or decreased cough.
- Prolongation of meals (45 - 60 minutes) with effortful chewing.
- Nasal regurgitation.
- Mouth odor (due to oral retention of food).
- Difficulty with oral preparation of bolus.
- Complaint of pain/obstruction during swallow.
- Hoarseness/temporary loss of voice.
- Gastroesophageal reflux.
- Motor planning disorders.
- Perceptual impairments.
The Swallowing Process
There are four main stages in the swallowing process
1. Oral preparatory stage: The food is chewed, mixed with saliva, and formed into a cohesive food ball (bolus).
2. Oral stage: The food bolus is moved back through the mouth with a front-to-back squeezing action, performed primarily by the tongue.
3. Pharyngeal stage: This stage begins with the pharyngeal swallowing response. The food enters the upper throat area (above the voice box), and the soft palate elevates. The epiglottis closes off the trachea as the tongue moves backwards and the pharyngeal wall moves forward. These actions help force the food downward to the esophagus.
4. Esophageal stage: The food bolus enters the esophagus (the tube that transports the food directly to the stomach). The bolus is moved to the stomach by a squeezing action of the throat muscles.
Swallowing Disorders and Eating
For many individuals suffering from swallowing disorders, the effort of chewing and swallowing turns a pleasurable experience into a burden. These individuals may need their foods prepared in a special way to make them safer and easier to swallow. Liquids or foods that are too thin can be just as hard to swallow as ones that are too thick. Depending upon the severity of your swallow pattern, your doctor or Speech-Language Pathologist may have you on a particular swallowing diet. The following website contains easy and safe swallowing recipes for individuals who may be on a restricted diet: www.als-mda.org/publications/meals.