DYSPHAGIA IS...
The technical term for a swallowing disorder or swallowing difficulty.
Pronounced "dis-fay-juh", it
has also been spelled "dysphasia" but the official spelling is with a
"g"
not an "s".
On average
people swallow about 580 times a day.
WHAT IS A SWALLOWING DISORDER?
Dysphagia is defined as
difficulty in swallowing, the
inability to swallow,
or a condition in which swallowing is difficult or painful.
There are
4 phases of
swallowing:
- Oral
Preparatory Phase- food
is chewed and manipulated in the mouth
- Oral
Phase - the tongue moves to push food toward the back of
the throat to "trigger" the swallow
- Pharyngeal
Phase - after the swallow is triggered, the food (also
known as a bolus)
moves down the upper portion of the throat known as the pharynx
- Esophageal
phase - the food moves past the pharynx and enters the
esophagus where it moves further down into the stomach
A person with dysphagia has a problem at one or more of these phases.
We have 2 "tubes" in our throat. One "tube" known as the
trachea (or
airway), is where
air goes in and out
of our lungs and past our vocal cords.
The other "tube" known
as the
esophagus,
is where
food and liquid
go down into the stomach.
Penetration is
when food or liquid goes into the
trachea and stays above the vocal cords
.
Aspiration
is when food or liquid goes into the trachea and goes below the vocal
cords
.
Both of these are
"undelightful"
to experience.
If you have ever breathed in with food or liquid in your
mouth, you know what I'm talking about.
You probably coughed uncontrollably. Your face turned
red, your eyes watered, and when people asked if you were
alright,
you might have said...
...it went
down the wrong pipe.
Coughing is the body's way
of getting food, liquid, and any other object out of
the airway. It also keeps things from going into the lungs.
Coughing is a
good thing
because that means the body feels something go into the airway.
The
problem
comes when a person has food or liquid go into their airway...
...and they don't feel it.
This is called
silent aspiration.
The only way this can be detected is through imaging studies such as a
modified barium swallow
study or MBS (see details below).
There are many signs and symptoms of swallowing difficulty or
dysphagia.
Some are:
- Inability to recognize food
- Difficulty placing food in the mouth
- Inability to control food or saliva in the mouth
- Coughing before, during, or after a swallow
- Frequent coughing at the end of a meal or right
after
- Weight loss when no other reason can be defined
- Wet vocal quality (speech sounds gurgly)
- Pneumonia
- Malnutrition
- Dehydration
WHAT CAN I DO
ABOUT IT?
The best
thing you can do if you
or someone you care for has dysphagia, is to follow the advice of the
Speech Pathologist who treats you. When necessary they will recommend a
specific diet to follow.
Follow
it...it's for your safety!
As a hospital intern I remember observing a patient of mine who was not
supposed to eat
anything,
in medical terms this is called NPO (nothing by mouth or "nil per os"
in Latin)
I
walked into his room one afternoon to see him lying on his back eating
a cheeseburger.
My supervisor and I were speechless and she was very
upset with him.
If you want to...
- spend more time in the hospital
- increase your chances of pneumonia
- improve your chances of dying
...by all
means, don't
follow the diet recommendation.
The
SLP may give you exercises and other suggestions. Practice your
exercises as often as possible and follow the suggestions for eating.
Some examples of eating suggestions may be:
- person should be well rested
- sip don't pour liquids into the mouth
- remove distractions (if person is easily
distracted)
- person should be seated upright at a 70-90
degree angle
- encourage the person to chew well before
swallowing
- encourage the person not to talk while eating
Additionally,
there are a variety of techniques an SLP can give someone with
dysphagia that will be specific to what problem(s) they are having,
such as:
- a chin tuck
- head turn toward weak side of the body
- re-swallow
An SLP should discuss these with you and help you use them at home.
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