Dysphagia

What are the types of dysphagia?

Dysphagia, or difficulty swallowing, can be a symptom of muscle disorders, nervous system disorders, brain disorders, and throat blockages. The treatment varies depending on the cause.

Treatment can include changing eating habits and even surgery.

The three types of dysphagia are:

• Oral dysphagia, which occurs in the mouth, can occur after a stroke, due to the tongue becoming weak. This makes it difficult to transport food from the mouth or chew food.
• Pharyngeal dysphagia, which occurs in the throat, is caused by neurological conditions like stroke, Parkinson’s disease, or amyotrophic lateral sclerosis (ALS).
• Esophageal dysphagia, which occurs in the esophagus, is caused by irritation or blockage, sometimes requiring surgery.

Which conditions cause dysphagia?

Nervous system and brain disorders

Conditions affecting the brain and nervous systems, such as multiple sclerosis, Parkinson’s disease, stroke, and amyotrophic lateral sclerosis, can make swallowing difficult.

Muscle disorders

Muscular dystrophy and myasthenia gravis affect the body’s muscles. Other disorders, like systemic sclerosis, esophageal spasms, and achalasia, can make it hard to swallow.

Esophageal narrowing

Disorders at the opening, middle, and closing of the esophagus can impede the passage of food, including swollen thyroid glands, which can narrow the esophagus.

Gastroesophageal Acid Reflux Disease

GERD leads to irritation of the esophageal lining and can cause ulcers, which make swallowing painful.

Sore throat

Pain and inflammation associated with a virus or bacterial infection can lead to a sore throat, which makes swallowing uncomfortable.

What are the risk factors for dysphagia?

As you age, the esophagus goes through normal wear and tear. Aging also increases your risk of developing Parkinson’s disease or having a stroke. As such, older adults have a higher risk of dysphagia. Individuals with some neurological disorders can also experience a range of physical symptoms that make it difficult or impossible to swallow without medical support.

What problems are caused by dysphagia?

Malnutrition and dehydration

When you have difficulty swallowing, it becomes hard to eat food and swallow fluids. If dysphagia goes untreated, getting sufficient nutrients can be difficult and patients can suffer from mild to severe dehydration if fluid intake is not carefully monitored.

Aspiration pneumonia

Sometimes when swallowing, the body will inhale food or liquid into the lungs, rather than down the esophagus. This can introduce bacteria into the lungs that cause pneumonia.

Choking

When food is stuck in your throat, it can lead to choking. It can be fatal when the food blocks the airway completely.

How is Dysphagia diagnosed?

If you notice the swallowing difficulty symptoms, talk to your doctor. The doctor will conduct a physical examination to check for any swelling.

Common tests include:

Flexible laryngoscopy

This test is typically performed by an ear, nose, and throat specialist (otolaryngologist or ENT). The doctor inserts a small scope through the nose and looks at your throat and vocal cords.

Esophagoduodenoscopy (EGD)

Also known as an upper endoscopy, the EGD test involves the gastroenterologist placing a scope down your throat. The scope continues down into the stomach and is used to check for tumors and narrowing.

Manometry

The study measures the pressure produced when your esophageal muscles are working. It is usually performed when endoscopy results are inconclusive.

Swallow study

The swallow study is performed by a speech therapist. It tests different liquid and food consistencies to see the one causing swallowing difficulty. The therapist may also do a video swallow to identify the problem.

Fiberoptic endoscopic evaluation of swallowing (FEES)

Typically performed by a speech-language pathologist, the FEES involves a small camera inserted into the nose. The SLP can then observe the behavior of your larynx and pharynx when you swallow and address any problems.

Modified barium swallow study

More complex than a typical swallow study, during the MBSS a speech-language pathologist will give you foods and liquids to swallow. The food is covered with a minty liquid known as barium, which allows the doctor to see X-ray images of your throat, mouth, and esophagus as you swallow.

How is dysphagia treated?

High Dysphagia (oropharyngeal)

High dysphagia is a neurological problem, making it challenging to provide an effective treatment. Here are ways high dysphagia is treated.

• Swallowing therapy: done with a language and speech therapist. You’ll be taught new ways of swallowing properly. Exercise will improve how your muscles respond.
• Diet: eat foods that are easier to swallow.
• Feeding through a tube: Patients at risk of dehydration or malnutrition will be fed with a nasal tube. The tubes are inserted into the stomach, and an incision is made to allow the tube to pass into the abdomen.

Low Dysphagia (esophageal)

Low dysphagia requires surgical intervention.

• Dilation: a balloon is inserted and inflated in the esophagus to make it wider.
• Botox: used if the esophagus muscles are stiff. It works by paralyzing any stiffened muscle and reducing constriction.

Do I need a feeding tube?

If you are unable to get enough vitamins and nutrients, you could risk malnourishment and weight loss. In such a case, your physician might recommend a temporary or permanent feeding tube, which bypasses esophageal problems and delivers nutrients directly to your stomach.

Does rehabilitation help with dysphagia?

Rehabilitation may help deal with swallowing problems. A speech-language pathologist (SLP) will teach you exercises that strengthen your swallowing muscles. The SLP may recommend the following:

• Changing your eating and drinking patterns: the therapist will guide you on chewing food thoroughly and taking smaller bites. It can be tough to swallow heavy liquids, so you’ll add a special thickening powder.
• Clear your throat: you’ll also learn how to clear your throat with a cough if food gets stuck.
• Sitting upright: the therapist will also show you how to sit properly when eating to reduce the chances of choking.

Dysphagia rehabilitation at Brooks

At Brooks Rehabilitation, we offer a wide range of rehabilitation services, including neuro recovery and speech therapy – ensuring good swallowing and eating.