Dysphagia and Swallowing Problems

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When you are eating food and drinking your favorite beverage, you probably do not think about what is happening in your mouth and throat to help get the food and drink down into your belly. Swallowing is such a natural occurrence that we often take it for granted. We assume that our body's swallowing mechanism will work. But sometimes, a problem occurs in the body and difficulty swallowing food or drink arises, a condition known as dysphagia.

A man drinking during a barium swallowing exam
Science Photo Library / Getty Images

What Is Dysphagia?

Dysphagia is defined as difficulty swallowing food or liquid due to illness or disease. It occurs when you need to take more time or effort to move food from your mouth to your stomach, or you may not be able to move the bolus (a mass of chewed food) from your mouth, resulting in choking or aspiration of the food.

When dysphagia happens, it is essential to get the problem solved to ensure that you can eat and drink safely.

Causes

There are many possible causes of dysphagia, either from an illness or injury. Common causes of dysphagia may include:

Since swallowing is such a vital function for the body and since a problem with swallowing can be injurious or fatal, it is essential that you do seek medical care to get properly diagnosed and treated.

Diagnosis

If you suspect you have dysphagia or swallowing problems, you must see your healthcare provider right away. Dysphagia can be dangerous, and getting an accurate diagnosis is essential. Your healthcare provider may refer you to an otolaryngologist, also called an ear, nose, and throat (ENT) doctor, or a gastroenterologist (GI). You may also be referred to a speech-language pathologist (SLP) who specializes in dysphagia and swallowing management.

Tests and measures that your healthcare provider may perform to diagnose your dysphagia may include:

  • In-office clinical examination: Your healthcare provider will look and listen as you swallow to determine which muscles are working properly and which are impaired.
  • Barium swallowing exam with videofluoroscopy: During this examination, an X-ray will be taken of your swallowing mechanism as you swallow barium, a white liquid visible on X-rays. The barium is opaque on the X-ray, and your healthcare provider can assess its path as it travels from your mouth as you swallow. The examination can be captured on video in real time for review.
  • Fiberoptic endoscopic examination of swallowing (FEES): A FEES entails having a small flexible fiberoptic tube inserted into your nasal cavity. A tiny camera is on the end of the tube. Your nasal area may be anesthetized prior to insertion of the tube. Once the camera is situated up your nose and into the back of your throat, you will eat bits of food, and your healthcare provider can see where food or drink is getting caught while you swallow. The test can be recorded on video for later review.

After one (or multiple) tests, your healthcare provider or speech therapist may be able to determine what is happening in your mouth and throat to cause your dysphagia.

Treatment

If you are diagnosed with dysphagia, your healthcare provider will refer you to a specialist for treatment. Your initial treatment should be to focus on the primary cause of your dysphagia. If you have a tumor or foreign object blocking your esophagus, your initial treatment will likely be the removal of the blockage.

If GERD (gastroesophageal reflux disease) is causing your swallowing difficulty, medication and dietary changes may be necessary to treat the problem. Once the primary problem is mitigated, you may still have some swallowing difficulty, and you may need to work with a specialist to fully recover normal swallowing function.

Many times, patients benefit from working with a speech therapist for their swallowing problems. Your speech therapist will perform an initial evaluation prior to offering any treatment. This evaluation may include:

  • An interview about your condition
  • Review of your past medical history
  • Review of the medication you are taking
  • Review of any testing you have done
  • Clinical evaluation of your mouth and tongue movement and assessment of your functional swallow
  • Development of treatment goals

Once your initial evaluation is complete, exercises and counseling will be done to start treating your dysphagia. Your therapist can show you which exercises are best for your condition. Exercises for dysphagia may include:

  • The Mendelsohn maneuver: As you swallow, keep your Adam's apple elevated for two to five seconds. Then, slowly allow it to lower down.
  • Shaker exercise: Lie flat on your back and raise your head up as if you were trying to look at your toes. Hold the position for a second or two, and slowly lower.
  • The Masako maneuver: To do this, protrude your tongue from your mouth and gently hold it between your front teeth. While holding your tongue with your teeth, swallow saliva.
  • Supraglottic swallow: To perform this, take a deep breath, hold it, and then swallow. After swallowing, clear your throat to rid it of any residue.
  • Lip oral motor exercises: These exercises include moving your lips in specific ways and forming specific shapes with your lips and mouth.
  • Jaw oral motor exercises: Simple jaw exercises and motions can help ensure your jaw is positioned correctly for swallowing.
  • Tongue exercises: Various movements with your tongue can help ensure it is in the right position and has adequate strength and range of motion for swallowing.

Your therapist may have you perform the exercises in the clinic or office, and the therapist will likely prescribe swallowing exercises as part of a home exercise program. Be sure to follow your therapist's directions carefully and ask any questions if you have any.

Before starting any exercise program for dysphagia, see your healthcare provider or speech therapist to be sure that it is safe for your particular condition.

Your therapist may also alter your diet to accommodate your dysphagia. The therapist may recommend thickening liquids to make swallowing them easier. Special thickening agents may be recommended for you to use when drinking to prevent liquid from sliding into areas of your mouth and throat that should be avoided while swallowing.

Prognosis

The prognosis for dysphagia is variable and largely depends on several factors. First and foremost, your specific diagnosis and cause of dysphagia may determine how long you'll have it. If you have had surgery or radiation treatment for cancer, your swallowing may return to normal with practice and as things heal.

If your dysphagia is caused by a neurological condition such as a stroke or multiple sclerosis, your outcome may be less predictable. Occasionally, your dysphagia may get better with exercises to improve your overall neuromuscular swallowing function.

Sometimes neurological problems are permanent, and your swallowing may be impaired despite your best efforts with therapy and exercises. If this is the case, alternative feeding techniques may be necessary. This may include a PEG (percutaneous endoscopic gastronomy) tube for nutrition. Your healthcare provider and treatment team can help determine the best way for you to proceed.

A Word From Verywell

Dysphagia and swallowing difficulties can be a scary condition to experience and can leave you feeling frustrated and anxious about consuming food and beverages. Swallowing problems can be managed well if they are diagnosed properly and if the right treatment is applied. If you feel you have dysphagia or problems with swallowing, check with your healthcare provider right away for proper management to ensure that you can quickly and safely return to your normal state of health.

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