Alexis Irazoque, M.S., CCC-SLP
When you think of speech therapy, you probably think of speech! While speech-language pathologists treat communication disorders, you may be surprised to know they treat dysphagia, or swallowing disorders, as well.
Maybe you know someone with dysphagia or have had swallowing difficulty yourself. In this article, we explore why swallowing problems can happen and how a speech therapist can help.
What is dysphagia?
Dysphagia means difficulty with swallowing. There are 4 main types of dysphagia:
Oral dysphagia – Involves the oral cavity, such as the lips, tongue, and soft palate
Pharyngeal dysphagia – Involves the throat
Esophageal dysphagia – Involves the esophagus
Gastroesophageal junction dysphagia – Involves the connection point between the esophagus and the stomach
These dysphagia types can also occur together, meaning a person can have oral and pharyngeal dysphagia at the same time (known as oropharyngeal dysphagia).
How common is dysphagia?
According to the American Speech-Language-Hearing Association (ASHA), it’s estimated that 1 in 25 adults experiences a swallowing problem each year. Because dysphagia occurs across many age groups and co-occurs with many diseases, the prevalence is not fully known. However, we do know that swallowing issues are more common among older adults and are associated with age-related muscle weakness (known as sarcopenia) or changes in bone structure within the neck or upper back.
What causes dysphagia?
Dysphagia can be related to nerve and/or brain damage associated with stroke, traumatic brain injury (TBI), spinal cord injury, head and neck cancer, multiple sclerosis (MS), Lou Gehrig's disease (ALS), dementia, Parkinson’s disease, and other neurological diseases.
Swallowing problems can also be associated with pulmonary diseases, acid reflux, muscle weakness, and side effects from certain medications.
What are the signs and symptoms of dysphagia?
Signs and symptoms of swallowing problems are different for each person. They can vary depending on the type of dysphagia. Some of the signs and symptoms of dysphagia include:
Drooling and/or difficulty managing food and liquids
Extra time and effort needed to chew and swallow
Unexplained weight loss
Pain when swallowing
Feeling like food is stuck in the throat (known as globus sensation)
Wet or gurgly voice during or after eating and drinking
Coughing/choking during or after eating and drinking
Difficulty coordinating breathing and swallowing
Recurrent pneumonia
Who treats dysphagia?
Speech-language pathologists, also known as speech therapists, play an essential role in assessing, treating, and managing swallowing disorders. They work along with other healthcare providers, like head and neck surgeons (ENTs), gastroenterologists (GI doctors), and even physical therapists, to assist with proper positioning when eating.
Speech therapists are trained to recognize signs of esophageal and gastroesophageal dysphagia. They can then refer the person to the right health care professional. Patients with progressive diseases and those within end-of-life care can also benefit from treatment with a speech therapist.
The impact of dysphagia
Dysphagia can cause medical complications, including aspiration pneumonia and malnutrition/dehydration.
Aspiration pneumonia: Swallowing difficulties can impact the body’s ability to protect the person’s airway, allowing food, liquid, and/or bacteria to reach the lungs. This is known as aspiration. Aspiration happens most often when a person becomes weak or injured and is no longer able to feed themselves and requires assistance with eating. Recurring episodes of aspiration can lead to upper respiratory infections and pneumonia. And sadly, pneumonia is the leading cause of death within older adults.
Malnutrition/dehydration: Malnutrition and/or dehydration can also occur if a person is not able to eat or drink enough because of their swallowing difficulties. When people have discomfort with swallowing, they may eat less than is needed for their caloric intake.
Dysphagia can impact many areas of a person’s life. In addition to medical complications, a person with dysphagia may have less interest or enjoyment related to eating and drinking. They may feel embarrassed and avoid social gatherings. In some cases, they may need diet modifications that significantly limit what they can eat.
Caregivers and family members of those with dysphagia can also feel a burden to ensure the safety of their loved one.
What happens during an evaluation for dysphagia
If you or a loved one is having a hard time swallowing, speak with your doctor. They can refer you to a speech-language pathologist for an evaluation. Speech therapists are the most qualified providers of dysphagia services because of their unique training.
The speech therapist will perform tests to gain a better understanding of your diagnosis and create a personalized treatment plan. The evaluation may include:
Screening – Pass/fail to determine if further testing is needed.
Review of your medical history – To learn more about your concerns, medical conditions, and any other contributing factors.
Oral mechanism and/or cranial nerve examinations – To assess the structures and muscles involved in swallowing, your ability to cough and throat clear, your head/neck control, etc.
Clinical swallow assessment – Trying food and liquids of varying consistencies and thickness while assessing your oral control and watching for signs or symptoms of aspiration.
Diagnostic tests with imaging – Allows speech therapists to evaluate the anatomy and physiology of the structures used for swallowing in order to determine if dysphagia is present and its severity, possible causes, and other clinical factors. Two diagnostic imaging tests can be done:
Videofluoroscopic Swallowing Study (VFSS) – Video swallow studies use barium and a moving X-ray. They are performed in the radiology suite.
Flexible Endoscopic Evaluation of Swallowing (FEES) – FEES uses a nasal endoscope. It can be performed in an outpatient setting or at the person’s bedside in many different medical environments.
How is dysphagia treated?
Treatment for swallowing difficulty is individualized. Treatment varies for each person based on the cause(s), symptom(s), and type of dysphagia. Speech therapists create a treatment plan that will improve a person’s swallow safety, support their nutrition and hydration, and improve their quality of life.
Treatment for swallowing problems can include the following elements:
Exercises
Used to rehabilitate your swallowing skills by improving your physiological functions, such as strength, range of motion, and coordination.
Compensatory strategies
Used to improve the safety and effectiveness of your swallow. These strategies might include pacing how you eat and drink, as well as changing your posture. Note that compensatory strategies do not improve your function over time like exercises.
Changes to diet
Used to increase swallowing safety. Your speech therapist might recommend changing the texture and/or thickness of your food and liquid, as well as the way it’s prepared (e.g., chopped or pureed). The taste and/or temperature of the food can be changed to increase your enjoyment of the food as well.
Other techniques
Other tools and exercises to treat dysphagia include swallow maneuvers, oral care education*, adaptive equipment, environmental modifications, sensory stimulation techniques, prosthetics, and feeding tubes. For people who need assistance with eating, an important goal will be to work toward regaining their ability to feed themselves in order to reduce the risk of aspiration.
*A clean mouth greatly improves the safety of a swallow. Aspiration of bacteria in the mouth creates a significant health risk.
How is treatment for dysphagia delivered?
According to ASHA, individuals diagnosed with dysphagia can receive therapy in various ways. Dysphagia therapy can be one-on-one, as part of a group during mealtime, and via telepractice, or online therapy.
Can dysphagia be treated through teletherapy?
Some types of swallowing therapy can be done through teletherapy, but not all. Some people may need the therapist to be physically present for safety reasons. This decision should be made by a speech therapist who specializes in swallowing. The speech therapist will consider the person’s diagnosis, severity of swallowing problems, current condition, and goals.
Dysphagia teletherapy requires planning and communication among the speech therapist, client, and/or their caregiver. Certain foods and liquids may need to be used during sessions as exercises and strategies are practiced. Each session also requires an additional person to serve as a facilitator. This person could be a family member, caregiver, or friend. It’s important to have another person to assist with preparing items, ensuring proper equipment placement, and as a safety while the person is eating.
Dysphagia teletherapy requires planning and communication among the speech therapist, client, and their caregiver.
No matter what goals are being targeted in dysphagia therapy, and whether therapy is online or in person, it’s extremely important for the client and/or caregiver to be involved. This way, the person with dysphagia can learn what to do at home to support their goals and stay safe while eating and drinking.
Talk with your doctor if you have concerns about swallowing
If you have concerns about your swallowing, talk with your doctor to rule out or discover any underlying condition(s). It’s also important to seek a referral for an evaluation by a speech-language pathologist. Speech therapists are an essential part of the health care team for dysphagia management.
When talking with your doctor, be prepared to discuss times of day or anything you do that makes the problem better or worse. You should also discuss medications, medical conditions, and any other concerns or symptoms you’re experiencing.
Additional resources
This article is meant to serve as an informative guide to swallowing problems, but it is not comprehensive. For more information, please visit these organizations: ASHA, The National Foundation of Swallowing Disorders, and the Mayo Clinic.
