Eating and swallowing food and drinks are an integral part of daily life and often go unnoticed or taken for granted until the process malfunctions (e.g. “goes down the wrong pipe”) resulting in coughing and choking. This happens to everyone once in a while and is considered normal. The increased frequency of this malfunction - coughing and choking as a result of food or drink “going down the wrong pipe” a lot of the time - is considered a swallowing disorder, also known as Dysphagia (dis-Fay-juh). 

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Stages of Swallowing

Swallowing happens in 3 stages. Problems with swallowing can occur in one or all of the stages:

1. Oral Phase - food or liquid enters the mouth and is moved by chewing, sucking or slurping toward the back of the throat. 
2. Pharyngeal Phase - food and liquid are squeezed down the throat (esophagus) and the epiglottis closes off the airway (trachea) to prevent food and liquid from entering the lungs. 
3. Esophageal Phase - The esophagus is the tube that carries food from the throat to the stomach. Food can get stuck in the esophagus, especially with conditions such as acid reflux.

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Signs and Symptoms of Swallowing Disorders

• Coughing/choking during or immediately following a bite or sip
• Clearing your throat frequently after eating or drinking
• A wet or gurgly sounding voice after eating or drinking
• A feeling of something being “stuck” in your throat or chest after eating/drinking.
• Noticing extra effort or time needed to chew and/or swallow
• Food or liquid leaking out of your mouth/lips
• Food remaining in your mouth after swallowing
• Pain when swallowing
• Difficulty breathing after meals
• Unexplained weight loss
• Recurrent Pneumonia

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Possible Consequences of Swallowing Disorders

• People experiencing swallowing difficulty may feel embarrassed about their eating and drinking and resort to eating alone.
• Dehydration and poor nutrition
• Aspiration (food/liquid entering the airway)
• Pneumonia or other respiratory infections
• Reflux
• Reduced quality of life

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Causes of Swallowing Disorders

• Degenerative diseases such as Parkinson’s Disease or Huntington’s Disease
• Dementia such as Alzheimer’s Disease
• Cerebral Palsy
• ALS (Amyotrophic Lateral Sclerosis)
• MS (Multiple Sclerosis)
• Traumatic Brain Injury (TBI)
• Stroke
• Spinal Cord or Neck Injuries
• Medications causing dry mouth
• Head and Neck Cancer
• Mouth or Neck Surgery
• Bad teeth, missing teeth or poor-fitting dentures

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Evaluation and Treatment for Swallowing Disorders

The first step when experiencing issues around swallowing is to speak with your doctor. They may refer you to a Speech-Language Pathologist who is qualified to conduct an instrumental assessment such as a Modified Barium Swallow Study (MBSS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES), typically conducted in a hospital or clinic setting. A non-instrumental assessment may also be performed and includes a review of medical history, vital signs check, assessment of the structures involved in swallowing,  cranial nerve assessment, posture and positioning assessment, secretion management skills (e.g. swallowing saliva) and oral care/hygiene status. Once a diagnosis of dysphagia is confirmed, therapy may be recommended.  

Treatment for dysphagia may be rehabilitative (restore swallowing function to normal) or compensatory (teach modifications/strategies to support safe swallowing). The Speech-Language Pathologist will teach exercises and techniques to support increased safety and efficiency during swallowing and may include diet consistency modifications. Every dysphagia treatment plan is individualized based on each person’s unique combination of circumstances. 

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Treatment may include: 

• Biofeedback
• Diet Texture modifications
• Electrical stimulation
• Maneuvers/Strategies
• Swallowing exercises
• Pacing and/or feeding strategies
• Postural and positioning techniques
• Prosthetics and intra-oral appliances
• Sensory stimulation

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Teletherapy for Swallowing Disorders

Tele-therapy is a unique platform to bring personalized intervention directly to a person’s home. Some swallowing disorders may be treated via tele-therapy, but others are best suited for in-person treatment, depending on the unique diagnosis and circumstances of each person. Swallowing treatment for adults via tele-therapy requires another support person to be present during each therapy session to help prepare food and drinks and support correct positioning for swallowing exercises. A speech-therapist who specializes in dysphagia treatment can help you decide if tele-therapy for swallowing is the best option for you. Tele-therapy for swallowing will educate the patient and support person on signs/symptoms to be aware of and techniques, strategies, diet modifications, etc. to be practiced and utilized during the session and throughout the week.