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What is dysphagia?

Dysphagia is a term that means "difficulty swallowing." It is the inability of food or liquids to pass easily from the mouth, into the throat, and down into the esophagus to the stomach during the process of swallowing.

What causes dysphagia?

To understand dysphagia, we must first understand how we swallow.

Swallowing involves three stages. These three stages are controlled by nerves that connect the digestive tract to the brain.

  • oral preparation / oral stage
    Food is chewed and moistened by saliva. The tongue pushes food and liquids to the back of the mouth towards the throat. (This phase is voluntary: we have control over chewing and beginning to swallow.)

  • pharyngeal stage
    Food enters the pharynx (throat). A flap called the epiglottis closes off the passage to the windpipe so food cannot get into the lungs. The muscles in the throat relax. Food and liquid are quickly passed down the pharynx (throat) into the esophagus. The epiglottis opens again so we can breathe. (This phase starts under voluntary control, but then becomes an involuntary phase that we cannot consciously control.)

  • esophageal stage
    Liquids fall through the esophagus into the stomach by gravity. Muscles in the esophagus push food toward the stomach in wave-like movements known as peristalsis. A muscular band between the end of the esophagus and the upper portion of the esophagus (known as the lower esophageal sphincter) relaxes in response to swallowing, allowing food and liquids to enter the stomach. (The events in this phase are involuntary.)

Swallowing disorders occur when one or more of these stages fails to take place properly.

Adult health problems that can affect swallowing include:

  • stroke or traumatic brain injury
  • neurological disease
  • tumor in the head or neck
  • irritation of the vocal cords after being on a ventilator for long periods of time
  • paralysis of the vocal cords
  • having a tracheostomy (artificial opening in the throat for breathing)
  • irritation or scarring of the esophagus or vocal cords by acid in gastroesophageal reflux disease (GERD)

Why is dysphagia a concern?

Dysphagia can result in aspiration which occurs when food or liquids go into the windpipe and lungs. Aspiration of food and liquids may cause pneumonia and/or other serious lung conditions.

Dysphagia may also lead to inadequate nutrition or hydration.

What are the symptoms of dysphagia?

Symptoms associated with dysphagia may include:

  • eating slowly
  • trying to swallow a single mouthful of food several times
  • drooling
  • a feeling that food or liquids are sticking in the throat or esophagus, or that there is a lump in these areas
  • discomfort in the throat or chest
  • congestion in the chest after eating or drinking
  • coughing or choking when eating or drinking (or very soon afterwards)
  • wet or raspy sounding voice during or after eating
  • tiredness or shortness of breath while eating or drinking
  • frequent respiratory infections
  • food or liquids coming out of the nose during or after a feeding
  • temperature spikes
  • weight loss

How is dysphagia diagnosed?

A Physician, Speech-Language Pahologist, or Occupational Therapist can evaluate the patient with dysphagia by performing various evaluative tests. Recommendations may be made regarding food and liquid substances that are easier or softer to swallow. Treatment may also include exercises, positions, or strategies to help facilitate a more efficient swallow.

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