Stroke, general aging, surgery and many other causes can give a person difficulty swallowing, but it's important to know when to see a doctor about it. Speech therapists and primary care physicians warn against waiting too long — the sooner, the better to receive treatment and speech therapy to correct the problem.
There are many different swallowing disorders, but oral pharyngeal dysphagia is one of the most common. Dysphagia affects an estimated 300,000-600,000 people every year in the U.S.; the elderly are at the highest risk. In fact, estimates suggest that between 10 to 30 percent of the elderly is affected by dysphagia.
Oral pharyngeal dysphagia can be caused by neurological damage such as from a stroke, brain or spinal injury; neurological disorders and degenerative diseases like multiple sclerosis, muscular dystrophy, ALS or Parkinson's disease; head and neck cancer and cancer treatment like radiation therapy; immune system problems like polymyositis or dermatomyositis and scleroderma, which cause weakness leading to dysphagia. Aging is also a risk factor for dysphagia due to muscle atrophy.
Symptoms to look out for include coughing or choking while eating, painful swallowing, regurgitating food, sensation of food getting stuck in the throat or chest, unexplained weight loss, difficulty initiating a swallow, difficulty controlling food in the mouth, inability to control saliva in the mouth, pocketing food and recurrent pneumonia.
When these symptoms are present, a visit to your primary care provider is in order. From there, you will likely be referred to a speech language pathologist specializing in swallowing disorders.
A speech language pathologist will observe and test the muscles of the mouth and throat. They may also conduct a series of more advanced tests including a fiberoptic endoscopic swallowing test or a modified barium swallow study. Both of these exams allow the speech language pathologist a better look at what is causing the dysphagia so a treatment plan can be developed to best rehabilitate the muscles contributing to the problem.
Rehabilitation exercises are the most commonly recommended form of treatment for a dysphagia diagnosis. For example, if a person's dysphagia is mainly causing food to sit in pockets in their mouth, the speech language pathologist might target the tongue for better clearance of mouth and/or compensatory strategies.
If the airway isn't closing during swallowing, then exercises would be used to strengthen the muscles for airway closure so the food/liquid is not inhaled into the lungs. In addition to exercises and compensatory strategies, the speech language pathologist may also recommend changing the consistency or type of food or drink that is consumed.
Speech therapy evaluation and treatment sessions for dysphagia occur in both inpatient and outpatient settings. Inpatient speech therapy is most often done at the patient's bedside in the hospital. Outpatient therapy is usually a continuation of the therapy conducted in the hospital for follow-up care, or whenever a person feels they are having difficulty swallowing and have been referred by the primary care physician.
Outpatient therapy can range from four to eight weeks of therapy, but can be longer. Most patients go to therapy once or twice a week, depending on the severity of the disease. Patients are, however, expected to complete a home exercise program on their own for faster return of function of the swallowing muscles.
If any of the warning signs of dysphagia are present, seek help from your primary care provider so that proper treatment can remedy the problem.