Swallowing Problems

Typically, we do not have to think about how we swallow unless something “goes down the wrong way.” Dysphagia (dis FAY juh) is another term for swallowing problems. A person who has dysphagia may experience pain when trying to swallow. Others may have difficulty swallowing food, liquid or saliva, and some people may be unable to swallow at all.

People who have trouble swallowing, or who may fall asleep or experience progressive fatigue during meals, are at high risk of getting food or liquids in their airway (aspiration). Aspiration can cause sudden or repeated episodes of choking (blocking the windpipe), pneumonia (an infection in one or both of the lungs) or combinations of these and other problems. These serious conditions can result in sudden medical emergencies or chronic illnesses that affect health and quality of life.

How Does the Swallowing Process Work?
Why Would I Develop a Swallowing Problem?
What are the Signs/Symptoms of a Swallowing Problem?
How can a Swallowing Problem Effect Me?
What Should I Do if I Think I Have a Swallowing Problem?

How does the swallowing process work?

Swallowing is a complex process that moves food and liquids from the mouth to the stomach. Swallowing involves the use of many nerves and muscles in the lips, tongue, mouth, throat and esophagus, which is the tube that connects your throat to your stomach (Figure 1). Swallowing occurs in stages including the following.

• Oral phase. Solid food is prepared in the mouth by chewing, using saliva to moisten and lubricate it. The tongue shapes and positions the food for transfer into the throat. The lips, tongue and soft palate prevent food or liquids from falling out of the mouth, either into the throat before it is ready to swallow or through the lips. The prepared food or liquid “ball” or bolus is then pushed toward the throat to start the swallow.
• Pharyngeal phase. The throat (pharynx) and the tongue propel the bolus downward to the opening of the esophagus while closing off the airway momentarily to prevent aspiration; this is why we stop breathing briefly when we swallow. The upper esophagus relaxes and is pulled open by the muscles in the throat and under the jaw. 

• Esophageal phase. The bolus then enters the esophagus, which closes tightly after the bolus has passed. The swallowing muscles then relax, and the esophagus, a muscular tube, squeezes the bolus downward to begin its journey into the digestive system.   

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Why would I develop a problem swallowing?

Any condition that damages or weakens the muscles and nerves used for swallowing can cause swallowing problems, such as

• Having a stroke or an injury to the head or spinal cord;
• Diseases that affect muscles, such as muscular dystrophy;
• Other brain or nerve diseases such as Parkinson’s disease and multiple sclerosis;
• Alzheimer’s disease and other kinds of dementia;
• Head and neck tumors;
• Side effects of certain medications; and
• Many other diseases, conditions or surgical interventions can result in swallowing problems.

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What are signs/symptoms of a swallowing problem?

General signs may include

• Coughing during or right after eating or drinking,
• Wet or gurgly sounding voice during or after eating or drinking,
• Extra effort or time needed to chew or swallow,
• Difficulty squeezing food or liquid down the throat,
• Food or liquid leaking from the mouth or getting stuck in the mouth,
• Recurring pneumonia or chest congestion after eating, and
• Weight loss or dehydration from not being able to eat enough.

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How can a swallowing problem affect me?

• Poor nutrition or dehydration
• Risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
• Less enjoyment of eating or drinking
• Embarrassment or isolation in social situations involving eating

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What should I do if I think I have a swallowing problem?

You should consult your healthcare provider to find out if there is a serious problem and what the cause might be. Your physician may refer you to a speech-language pathologist for further evaluation and treatment.

Consultations and comprehensive evaluations are available for both inpatients and outpatients to objectively document the level of functioning and provide a baseline against which to compare recovery.  Patient and family education are an integral part of the services provided.  Ongoing individual treatment programs are designed for those patients whose deficits are amendable to direct treatment intervention and are conducted one on one with a licensed and nationally certified speech-language pathologist.

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For more information, call Speech-Language Pathology Services in Rehabilitation Services at the University of Tennessee Medical Center at 865.305.9151.

 

 

* Information was adapted from James Coyle’s (2001) article “Swallowing Problems in Adults” that appeared in the American Speech-Language Hearing Association’s “Let’s Talk” series.