Swallowing Tests After a Stroke

A stroke can lead to difficulty swallowing, which is referred to as dysphagia. This can cause serious complications if your food goes down the wrong pipe. Choking and aspiration pneumonia are two of the complications of dysphagia. If you have dysphagia, it could be caused by problems with the neurological control of your swallowing reflex, or by impairment of the nerves that control the muscles of your mouth or throat.

Dysphagia is so common and problematic among stroke survivors that screening is often recommended to identify swallowing problems before they cause complications.

Clinical Guidelines for Dysphagia Screening

Clinical guidelines jointly published by the American Heart Association and American Stroke Association strongly recommend early dysphagia screening for acute stroke patients to identify dysphagia or aspiration, both of which can lead to pneumonia, malnutrition, dehydration, and other complications.

A woman with impaired swallow function
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Dysphagia Evaluation

Before you begin any dietary changes or swallow therapy, you will need an evaluation of your swallowing function so that your instructions can be tailored to your problem. A swallow evaluation requires consultation with a speech and swallow specialist. The evaluation will assess the following.

Your Swallowing History

The first step in your evaluation is centered on your experience and your description of your swallowing problem. You should describe the changes you have experienced since your stroke when it comes to chewing and swallowing your food.

Common problems include:

  • Choking after drinking thin liquids, such as water or orange juice
  • Difficulty swallowing foods that are difficult to chew
  • A sensation that food is stuck in your throat or in the middle of your chest
  • A need to cough every time you swallow solid or liquid foods
  • Changes in your voice after eating, prolonged periods of hoarseness
  • Frequent respiratory infections
  • Frequent pooling of saliva in the mouth
  • Frequent episodes of indigestion
  • Progressive, unintended weight loss
  • Taking a long time to finish each meal

Physical Examination

Your physical examination is a very important step in a dysphagia evaluation. This may be done at the bedside if you are in the hospital, or in an outpatient clinic if you have already returned to your home.

  • While you are in the hospital, your nurse may test your ability to swallow right after you are diagnosed with a stroke. If your swallowing function shows any signs of impairment, you would need a consultation with a speech and swallow specialist. Generally, for safety reasons, you would not be permitted to eat until a formal swallow study is done.
  • Your speech and swallow specialist will speak with you to evaluate your voice and speaking ability, which is closely tied to your swallow ability.
  • Your swallowing specialist will observe how well your swallowing muscles move. This evaluation will determine which nerves, muscles, and reflexes are impaired.
  • You may then be given food and liquid to swallow, with an evaluation of which types of foods are most troublesome for you, and which foods you can more easily chew and swallow.

Diagnostic Testing

After your physical examination, your speech and swallowing specialist may need to obtain further tests to pinpoint specifically the type dysfunction that is causing your problem.

The following tests may be used to further evaluate the swallowing mechanism:

  • Barium swallow: An X-ray image of the esophagus taken as you swallow to determine whether you have dysfunction in the lower esophagus or stomach
  • Modified barium swallow: An X-ray image of your throat and upper esophagus to evaluate muscle movements during swallowing
  • Upper endoscopy: A diagnostic test that uses a camera to visualize your throat, esophagus, and stomach to observe your muscle movements and identify any lesions or anatomical abnormalities

A Word From Verywell

If you have dysphagia, you will likely need certain interventions to manage it. These include modifications of the type and consistency of your food to avoid hard foods that are difficult to chew and swallow, as well as avoidance of thin liquids that you could easily choke on. You may be instructed to eat in a certain position to prevent choking. And you may also need therapy sessions to help you improve your swallowing function.

If it is not safe for you to swallow anything by mouth, you may need a feeding tube in order to get nutrition, A feeding tube is inserted into your nose or stomach. As you recover from your stroke, your speech and swallow specialist will continue to evaluate your progress to determine when it’s safe to have your tube removed and to eat a wider variety of foods.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. O'Rourke F, Vickers K, Upton C, Chan D. Swallowing and oropharyngeal dysphagia. Clin Med (Lond). 2014;14(2):196-9. doi:10.7861/clinmedicine.14-2-196

  2. Warnecke T, Im S, Kaiser C, Hamacher C, Oelenberg S, Dziewas R. Aspiration and dysphagia screening in acute stroke - the Gugging Swallowing Screen revisited. Eur J Neurol. 2017;24(4):594-601. doi:10.1111/ene.13251

  3. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016 Jun;47(6):e98-e169. doi: 10.1161/STR.0000000000000098.

  4. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: An overview. Curr Phys Med Rehabil Rep. 2013;1(3):187-196. doi:10.1007/s40141-013-0017-y

  5. American Speech-Language-Hearing Association. Adult dysphagia.

Additional Reading

By Jose Vega MD, PhD
Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke.