Dysphagia, or difficulty swallowing, is not a disease itself, but rather is brought on by other diseases. Some cases of dysphagia are mild and easily treatable, while others are more serious and can be life-threatening. It may be difficult to find the best treatment, but they are out there, and speech pathologists will find the most suitable one for a specific condition.
Phases of Swallowing The whole swallowing process is rather complex and it involves over 40 pairs of muscles. It is important to know the different phases of swallowing because dysphagia may occur in either the second and third phase. Targeting the treatment to a specific area will give the best results. Oral Phase Food or drink enters the mouth and gets pushed into the back of the mouth toward the upper part of the throat. Here, both breathing and swallowing occur.
Oropharyngeal Phase The food and drink moves down the throat while various muscles briefly shut off breathing, direct the food or drink away from the breathing tube that leads to the lungs, and guide the food and drink into the esophagus and stomach.
Esophageal Phase This phase starts when the food or drink encounters a one way valve called the upper esophageal sphincter. After passing through this sphincter, the food or drink travels down the esophagus to the lower esophageal sphincter. Swallowing is complete when this latter sphincter relaxes, allowing the food or drink to drop into the stomach. Types of Dysphagia In young people, the most common cause of dysphagia is inflammatory muscle disease and two kinds of obstructions that can form in the esophagus. In older adults, dysphagia usually results from central nervous system problems, such as a stroke or Parkinson’s. Below are the two different types of dysphagia along with some of (but not all) their causes.
Oropharyngeal Dysphagia—causes a swallowing problem before the food or drink reaches the upper esophagus. Causes:
- Head or neck cancer
- Zenker diverticulum
- Post-surgical/radiation stenosis
- Infections (tonsil enlargement)
- Brain tumor
- Head injury
- Multiple sclerosis
Esophageal Dysphagia—the problem arises after the food or drink reaches the upper esophagus. Causes:
- Benign or malignant tumors
- Foreign bodies
- Mediastinal mass
- Enlarged right atrium
- Esophageal spasm
- Diabetes mellitus
- Radiation esophagitis
Treatment for Dysphagia Several types of healthcare providers will meet to figure the best treatment for a patient of dysphagia: physicians, registered dietitians, psychologists, speech pathologists, and occupational therapists. During treatment, the goal is to provide treatment and adequate nutrition while protecting against complications such as pneumonia from food or liquid getting into the lungs.
- Special considerations (all may not apply to some patients)
- Sit upright when eating or drinking
- Continue to sit upright for 30-45 minutes after eating
- Take small bites
- Eat slowly
- Avoid talking while eating or drinking
- Do not mix solid foods with liquid foods in one mouthful
- Do not wash foods with liquids after you have swallowed, unless directed otherwise
- Special diets consisting of “food levels”
- Level 1 = pureed foods
- Level 2 = minced foods
- Level 3 = ground foods
- Level 4 = chopped foods
- Level 5 = modified regular foods
- Sometimes surgery or medication may help, but not in every case
- Muscle exercises to strengthen facial muscles or improve coordination
- Learning to eat in a different way (for example, turning the head to one side while eating)
- Preparing foods in a certain way
- In those when oral feeding cannot possibly work, other methods may need to be used, such as a feeding tube that bypasses the swallowing mechanism