People can have trouble swallowing for many reasons. We sent our questions to Jennifer Witte, SLP, speech-language pathologist, Parkview Therapy Services, who explained some of the causes.
What is the role of a speech-language pathologist in helping patients with swallowing challenges?
Speech therapy is more than just “talk!” Speech-language pathologists (SLPs) are trained to evaluate and treat many problems/areas, including speech, language, comprehension, stuttering, voice disorders, cognition and swallowing. I have often tried to explain to patients that I’m focused on care “from the neck up.” The muscles we use for producing voice, speech sounds, chewing and swallowing food/liquid, are all within my scope of practice.
What are the different kinds of swallowing issues?
Swallowing can be divided into three phases: Oral, pharyngeal and esophageal. The oral phase involves preparing and moving the food bolus, the pharyngeal phase initiates the swallow reflex and directs the bolus into the esophagus and the esophageal phase propels the bolus down to the stomach. Swallowing therapy by an SLP can address the oral and pharyngeal phases.
Issues with the oral phase can include any difficulty with chewing food, managing liquids within the mouth, and preparing and propelling the food/liquid to the back of the mouth. Issues with the pharyngeal phase can include delay in swallow response, inability to move food/liquids completely through the throat, food/liquids entering the airway, the ability to protect the airway during the swallow and the ability to move the food/liquids into the esophagus.
What are some of the risks associated with swallowing issues?
Persons with swallowing difficulties, also known as dysphagia, can experience a wide range of problems at varying degrees of severity. Any dysphagia can negatively impact your ability to meet your nutritional needs, drink enough fluids or even get medications to your stomach to be processed by your body to help with other medical issues or diagnoses.
Choking and coughing after swallowing can be embarrassing, scare other people and may limit your interest in eating with others. Eating is a very social activity and not being able to eat “regular foods” and “regular liquids” can be isolating.
A person with severe dysphagia may not be safe eating or drinking any food or liquids. They may need a feeding tube. These can be placed in the nose leading into the stomach, directly in the stomach or even directly in the small intestine.
Why do some people have swallowing issues?
Swallowing difficulties can arise from various causes, including structural problems in the esophagus, neurological disorders, muscle weakness and certain medical conditions. Some common causes include neurological damage from stroke or head injuries, muscle disorders and issues with the esophageal muscles or nerves.
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Neurological conditions like stroke, dementia, Parkinson's disease, multiple sclerosis and ALS can affect the nerves and muscles involved in swallowing, leading to difficulty coordinating the swallow.
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Muscle weakness in the muscles of the mouth, throat or esophagus can make it difficult to move food and liquids down into the stomach.
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Esophageal problems like a narrowing of the esophagus (esophageal stricture), esophageal spasms and the presence of tumors can obstruct the flow of food and liquids.
Other medical conditions, like acid reflux, hiatal hernia and certain cancers can also cause swallowing problems.
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Head and neck injuries/surgeries can damage the nerves and muscles involved in swallowing, leading to dysphagia.
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Age-related changes, such as weakened muscles of the mouth and throat may increase the risk of swallowing difficulties.
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Developmental or learning disabilities may have difficulty coordinating the swallowing process.
Is there anything else you would like people to know?
Swallowing disorders affect more than just the patient. Families and caregivers are crucial team members when dealing with a patient experiencing dysphagia.
Also, swallowing therapy is not just for adults. Children can have difficulty tolerating different textures and liquids. “Picky eaters” aren’t always just finnicky. They can have sensory issues, structural issues, problems with the nerves and muscles for swallowing and difficulty swallowing related to breathing, developmental delays, reflux, weakness and poor coordination.
One more thing I would mention is, those with heartburn shouldn’t brush the symptom off. This can be treated, and symptom management can not only improve the joy of eating, but it can also help you avoid some rather unpleasant problems if left untreated, such as:
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Esophagitis: Inflammation of the esophagus.
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Esophageal stricture: Narrowing of the esophagus.
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Barrett's esophagus: Changes in the lining of the esophagus that can increase the risk of esophageal cancer.
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Respiratory problems: Cough, asthma and laryngitis.
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Tooth erosion: Acid reflux can damage tooth enamel.
If someone is experiencing swallowing issues, what should they do?
Seek the advice of your primary care provider. Remember that it is not normal to cough/choke/clear throat/sound gurgly after swallowing. Swallowing disorders can be fatal, as choking/obstruction can cause aspiration pneumonia, an infection of the lungs due to bacteria as food/liquids/medications are not absorbed/processed in the lungs as they are in the stomach.
To learn more about the speech therapy program at Parkview, click here.
