Dysphagia (pronounced “dis-fay-juh”) means difficulty swallowing. Dysphagia can affect people throughout their lifespan, but more often impacts older adults, babies, or people with neurological problems.
The muscles of the head and neck move intricately for many functions. Beyond articulating words with your tongue and lips, the muscles of the mouth and throat must work in syncrhony in the essential process of swallowing. These muslces are responsible for coordinating chewing, mixing food with saliva, moving food or liquid (called a bolus) from the lips to the back of the mouth, and then propelling it down the throat into the esophagus towards the stomach, bypassing the airway. Any difficulty in this process is called dysphagia.
CAUSES OF DYSPHAGIA
Dysphagia can be caused by a variety of factors, ranging from structural abnormalities to neurological conditions. Here are some of the primary causes:
Neurological Disorders
- Stroke: A stroke can damage areas of the brain responsible for controlling swallowing, leading to dysphagia.
- Parkinson’s Disease: A progressive neurological condition that can affect the muscles involved in swallowing.
- Multiple Sclerosis (MS): MS can cause disruptions in nerve signals, impairing swallowing function.
- Amyotrophic Lateral Sclerosis (ALS): ALS, also known as Lou Gehrig’s disease, causes muscle weakness and loss of coordination, including those needed for swallowing.
- Dementia: Cognitive decline from conditions like Alzheimer’s disease can affect the ability to swallow properly.
Muscular Disorders
- Myasthenia Gravis: A condition where the muscles become weak, impairing swallowing.
- Scleroderma: A disease that causes hardening and scarring of connective tissue, which can interfere with the muscles of the esophagus, making it difficult to swallow.
- Esophageal Spasm: Abnormal contractions of the esophagus that can make swallowing painful or difficult.
Structural Abnormalities
- Esophageal Strictures: Narrowing of the esophagus due to scarring, which can be caused by acid reflux, radiation therapy, or injury.
- Gastroesophageal Reflux Disease (GERD): Chronic acid reflux can lead to inflammation and scarring, narrowing the esophagus and causing swallowing difficulties.
- Tumors or Cancer: Growths in the mouth, throat, esophagus, or surrounding structures can obstruct the swallowing pathway.
- Zenker’s Diverticulum: A pouch that forms at the back of the throat, which can collect food and interfere with swallowing.
Aging
As people age, the muscles involved in swallowing can weaken, and the overall coordination of swallowing may decline, leading to dysphagia.
Infections
- Throat Infections: Infections like tonsillitis, pharyngitis, or laryngitis can cause pain and swelling that make swallowing difficult.
- Esophagitis: Inflammation of the esophagus, often due to infections, can cause dysphagia.
Obstructions
- Foreign Bodies: Swallowing food or objects that are too large or incorrectly chewed can create blockages in the throat or esophagus.
- Enlarged Tonsils: In children, enlarged tonsils or adenoids can block the airway and make swallowing difficult.
Medications
Certain medications can cause difficulty swallowing as a side effect, either due to their effects on muscle function or by causing dryness in the mouth or throat.
Radiation or Surgery
- Radiation therapy to the head, neck, or chest area can damage the tissues and muscles involved in swallowing.
- Surgery involving the throat, esophagus, or surrounding structures can lead to scarring or weakness that affects swallowing.
Psychological Factors
Some people experience difficulty swallowing due to stress or anxiety, sometimes referred to as “globus sensation,” where a feeling of a lump in the throat may occur.
Congenital Conditions
Some people are born with conditions that affect their ability to swallow, such as structural issues or neuromuscular disorders.
SIGNS AND SYMPTOMS OF DYSPHAGIA
Dysphagia, or difficulty swallowing, can present with various signs and symptoms. These can range from mild discomfort to severe difficulties that may affect a person’s ability to eat or drink properly. Here are some common signs and symptoms:
- Coughing, throat clearing or choking during or right after eating or drinking
- Wet-sounding voice during or after eating or drinking
- Extra effort, time, or pain when swallowing
- Food or liquid leaking from the mouth, getter tuck, or being held in the mouth (often the weaker side)
- Recurring pneumonia or chest congestion
- Difficulty swallowing medications
- Feeling of food or liquid being “stuck”: This sensation may occur in the throat or chest, and it’s often described as something being lodged in the esophagus or throat.
- Food or liquid coming back up into the mouth, or enters the nose: This can happen soon after swallowing and may be accompanied by a sour or bitter taste.
- Difficulty swallowing saliva, leading to drooling or spitting frequently. This is often seen in neurological conditions where muscle coordination is affected.
- Avoiding specific foods and/or unintended weight loss
If someone experiences any of these symptoms, it’s important to seek medical evaluation. Dysphagia can sometimes be a sign of a serious underlying condition that requires treatment or therapy to prevent complications like choking, aspiration, pneumonia, or significant weight loss.
A SERIOUS CONDITION
Dysphagia can be a serious condition, depending on its underlying cause and severity. While some cases may be mild and manageable, others can lead to significant health risks if left untreated. Here are some of the reasons why dysphagia can be considered serious:
Choking and Aspiration
Difficulty swallowing increases the risk of food or liquid becoming lodged in the airway, potentially causing choking. This is especially dangerous as it can lead to suffocation. Dysphagia can also cause food or liquids to enter the lungs instead of the stomach, leading to aspiration. This can cause respiratory infections such as pneumonia, which can be life-threatening, particularly in older adults or those with weakened immune systems.
Malnutrition and Dehydration
People with dysphagia may find it difficult to eat or drink enough to meet their nutritional and hydration needs. This can lead to malnutrition and dehydration, which can weaken the body and increase the risk of other health problems like infections, muscle weakness, and poor wound healing.
Weight Loss
Unintentional weight loss due to difficulty swallowing or avoiding certain foods is common in individuals with dysphagia. Severe weight loss can lead to muscle wasting, weakness, and fatigue, further complicating the person’s overall health and ability to recover from illnesses.
Risk of Recurrent Infections
Chronic aspiration of food or liquids into the lungs can result in repeated respiratory infections, including aspiration pneumonia. This condition is particularly dangerous for elderly individuals or those with neurological conditions.
Impact on Quality of Life
Dysphagia can significantly affect a person’s quality of life. It can lead to social isolation
IF YOU HAVE DYSPHAGIA
If you think you might have dysphagia, ask your doctor for a referral to a speech therapist.
An initial assessment is essential in identifying the cause of dysphagia, and will include a thorough history of the signs, symptoms, and medical condition you are experiencing, also noticing any medications you are taking. Evaluating the various muscles involved in swallowing is important. Often you might also be observed during a mealtime or swallowing liquids to note the process, movements, your posture, etc. The speech therapist might also recommend a modified barium swallow study (MBSS) to observe your swallowing process under an x-ray called video fluoroscopy, or an endoscopic assessment (FEES) using a lighted tube with a camera inserted through your nose to view the swallowing process.
Managing dysphagia with the expertise of a speech therapist can help people improve the impairments responsible for the dysphagia or utilize techniques to help compensate for lost function. Treatment for dysphagia may include:
- Exercises to strengthen the muscles used for swallowing
- Techniques to improve swallowing
- Strategies to decrease the impact of dysphagia
- Modifying the texture of foods and liquids
- Modifying the feeding environment