Swallowing problems (dysphagia) can occur in the mouth, throat, or esophagus. The act of swallowing is divided into three phases:
- Oral phase - moving food or liquid from the mouth into the throat
- Pharyngeal phase - squeezing food down the throat and closing the airway
- Esophageal phase - relaxing and tightening the openings at the top and bottom of the esophagus (the tube leading to the stomach) and squeezing food through the esophagus into the stomach
Signs and symptoms of dysphagia:
- Temperature spikes (or low-grade fever)
- Drooling or a feeling of "increased saliva" (may indicate the person is not swallowing his/her saliva)
- Weight loss
- Pocketing of food in the mouth
- Changes in diet
- If the patient reports trouble swallowing
Dysphagia can be grouped into these categories:
Can include: food or liquid leaking out the front of the mouth, difficulty chewing, difficulty forming the food into a cohesive bolus (ball), trouble moving the food back in the mouth toward the throat, food remaining in the cheeks or on the tongue, etc.
Oral dysphagia usually occurs as a result of other conditions, such as decreased saliva, painful mouth lesions, dementia, oral cancers, strokes, or after oral cancer surgery.
Can include: weak upward and forward movement of the of the larynx (voice box), inability to protect his/her airway (to block food or liquid from traveling into the airway), inability to close the vocal folds to protect the airway, weak throat contraction, residue from food or liquid remaining in the throat, food/liquid entering the airway, etc.
Pharyngeal dysphagia can be related to neurological disorders, head or neck radiation therapy, generalized weakness, recent breathing tube placement and removal (such as after a surgery), placement of a tracheostomy tube, or nerve damage.
Neurological causes include: stroke, head or spinal cord injury, myasthenia gravis, Guillain-barre, Alzheimer's dementia, ALS (amyotrophic lateral sclerosis), Parkinson's disease or multiple sclerosis.
May result in poor nutrition or dehydration, weight loss, aspiration (food or liquid entering the airway), pneumonia, respiratory problems, or embarrassment in social situations involving eating.
The first step in determining if someone has a swallowing problem is a swallow screen, usually performed by a nurse. If risk factors for swallowing difficulty are identified, the physician will order a swallow evaluation.
The evaluation is performed by a speech-language pathologist, who checks the patient's oral motor skills (to see if the person can move his/her mouth, form words, etc.), respiratory status, ability to manage saliva, and other factors. The patient is provided with food and liquid of different textures, and his/her tolerance of each is assessed.
If the patient shows signs of aspiration (food in the airway or lungs), special tests may be required, including: