Dysphagia (pronounced “ dis-FAY-juh”) means difficulty swallowing. This disorder can occur at any time of life, but is most often seen in the older adult population, infants, and people with a neurological condition.

Difficulty swallowing does not just mean it is hard to swallow food, so look out for the following signs and symptoms!

• Frequent episodes of gagging, coughing or choking during or after eating/drinking
• Difficulty managing saliva (drooling)
• Difficulty closing lips
• Wet vocal quality during or after eating/drinking
• Running nose during or after eating/drinking
• Watery eyes during or after eating/drinking
• Frequent bouts with pneumonia
• Frequent upper respiratory infections
• Swallowing food whole in order to “get it down” fast without anyone noticing a problem
• Eating/drinking quickly
• Extra effort or time to chew and/or swallow
• Pain with swallowing
• Pocketing food or liquid in cheeks
• Loss of food or liquid
• Frequent vomiting
• Weight loss or dehydration from inadequate intake
• Weak facial muscles

Download our checklist here if you think you have dysphagia. Discuss your results with your doctor or health care provider. Your primary care physician may recommend you seek the help of a Speech-Language Pathologist for your dysphagia.

Causes of Dysphagia

As stated previously, dysphagia is often a condition seen in the older adult population, infants, and people with a neurological condition.

When it is found in the infant population, it is often related to a premature birth. Children born too early are not physiologically prepared to perform what is known as, “suck, swallow, breathe.” Premature infants have limited mouth strength and lung capacity to complete an entire feeding session. Speech and occupational therapists often support infants who experience dysphagia.

In the older adult population, dysphagia can occur due to the aging process, as a medication side effect, with physical positioning problems, due to gastroesophageal reflux disorder (GERD), dry mouth, with surgeries to the head and neck, and with cancer after radiation.

A swallowing disorder can occur with particular types of neurological conditions with one of the most common being stroke patients. Studies show that an estimated 65% of stroke patients may experience dysphagia. Other common neurological conditions where one has difficulty swallowing, include Dementia, ALS, Multiple Sclerosis, Parkinson’s Disease, and Cerebral Palsy.

The Process of Swallowing

Most people do not think about how we swallow food or drinks. It is a skill we often take for granted. Swallowing is quite a complicated series of coordinated movements that use a large number of the muscles in the mouth, throat, and esophagus (the “wrong pipe” that leads to the stomach). In order to demonstrate how complicated swallowing truly is, take a glance at the stages of swallowing and what occurs at each stage!

Stage 1: Oral Preparatory Stage   

• Food enters the mouth, is chewed and mixed with saliva. This stage requires the efforts and movement of the teeth, tongues, lips and cheeks. For liquids, it is especially import for the lips to maintain a seal.
• This stage can be impaired by postural control, behavior, dry mouth, or weakness.

Stage 2: Oral Stage

• Food is moved to the back of the mouth after having been chewed to the proper consistency. The tongue squeezes food against the roof of the mouth (palate). The food is then passed backward where it enters the throat (pharynx) and swallow begins. A good lip seal, adequate tongue movement, and strong cheek muscles are required for this stage.
• This stage can be impaired by postural control, dry mouth, dental problems, muscle weakness, and decreased oral motor coordination including the tongue, lips, or cheeks.

Stage 3: Pharyngeal Stage

• Swallow is initiated when food enters the pharynx. Simultaneously, the larynx (the wrong “pipe”) is closed off to prevent aspiration (food or liquid in the airway). A muscular valve relaxes allowing food to enter the esophagus.
• This stage is often impaired due to neurological damage.

Stage 4: Esophageal Stage

• Waves of tiny muscle contraction and gravity allow food to enter into the stomach.
• This stage is often affected by irritation or a blockage.

Why is Dysphagia a Serious Medical Condition?

Outside of the fact that eating/drinking with family and friends is a form of fellowship and fun, dysphagia can cause other profound issues. Malnutrition, dehydration, and unintended weight loss can occur. Aspiration (food going down the wrong “pipe”) can lead to infections and pneumonia. To prevent these issues, it is important to report signs/symptoms of dysphagia to your medical provider and seek the support of a Speech/Language Pathologist to address the issue.

Swallowing difficulties can be very stressful! However, being your own advocate and speaking to your doctor or Speech Therapist can get you the help you need to manage your dysphagia, protect your airway, and keep you healthy!

Karen Ross, SLP
Trio Rehabilitation & Wellness Solutions
Boerne, Texas