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Dysphagia

Difficulty swallowing is a common problem

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Dysphagia is a common problem involving difficulty swallowing food and liquids. There are three phases involved in swallowing: oral, pharyngeal and esophageal. Any disruption to those phases causes dysphagia.

Dysphagia is caused by a lot of different factors such as a prolonged stay in the hospital that causes weakness and deconditioning. Patients with underlying pulmonary issues are most affected. Patients with progressive neurological diseases such as cerebral palsy, Parkinson's, ALS and multiple sclerosis disease often have problems swallowing. People with cancer of the head, neck or esophagus can also be impacted. People with dementia may have memory loss and cognitive decline that may make chewing and swallowing difficult. Gastro esophageal reflux disease (GERD) also causes swallowing problems.

During swallowing the larynx must raise and come forward so the epiglottis keeps the airway sealed. Symptoms of an underlying swallowing problem include coughing while eating, patients who need to clear their throat while eating, food sticking in the throat, eyes watering and nose running.

Kellie McGee, speech language pathologist with Texas Health Harris Methodist Hospital Alliance in Fort Worth, said, "Little particles of food can fall into the airway eventually causing aspiration pneumonia."

Typically hospitalized patients with swallowing disorders are evaluated by a speech pathologist during a bedside swallow exam where they are evaluated eating and drinking a variety of textures. A five-minute modified barium swallow (MBS) exam is done in radiology and allows the speech pathologist to see the impact of the patient consuming liquids and food as the substances pass through the three phases of swallowing.

Observing the swallowing process in this manner enables the speech pathologist to be able to teach the patient different swallowing and positioning strategies in addition to trying different textures and thickness of liquids.

Another technique for diagnosis is fiber optic endoscopic evaluation of swallowing or (FEES.) A lighted, flexible endoscope is introduced trans nasally to view the upper pharynx while the digestion of different textures is video recorded.

Dysphagia can be serious and keep people from being able to eat enough to stay health and maintain an ideal weight. Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. While lying down or sleeping, a person with this problem may draw undigested food into the throat. The esophagus may also be too narrow causing food to stick.

There are different types of treatment. Exercise-based treatment helps patients who have muscles weakened by a stroke or other condition. Muscle exercises can strengthen weak facial muscles to improve coordination. For others, treatment my involved learning to eat with their head turned a certain direction. Food may need to be prepared a certain way and some kinds of food or liquids might need to be changed or avoided.

Speech therapists teach patients compensatory strategies to enable them to digest foods and liquids with greater ease.

According to Joanna Brown, manager of speech-language pathology at Parkland Hospital in Dallas, a technique developed within the past 10 years is electrical stimulation. This technique targets muscles using neuromuscular electrical stimulation. An instrument is placed on the muscles of the throat that helps strengthen them. Speech therapists certified by the medical equipment device manufacturer are trained in the correct technique.

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"I consider myself a risk assessor because I'm always asking myself how can I help this patient and safely reduce their risk? Their MBS gives me a snapshot of what amount of risk the patient is in." McGee said.

Dysphagia is a common medical issue and McGee works with a couple of patients daily affected with the disorder in an acute hospital setting. In addition to helping diagnosis the condition and teaching patients how to manage it, McGee also instructs patients and staff on the importance of oral hygiene. When a patient's mucus is thick and their mouth is dry they risk aspirating on their own mucus.

Dysphagia is an area that is constantly being researched and new literature is published keeping track of new methods for treatment. Every aspect of the swallowing process is being studied in people of all ages to give researchers a better understanding of how normal and abnormal processes compare.

Bridget Barry Thias is a freelance writer.


 

The old thought of runny nose and eye watering indicating aspiration or swallowing difficulty has never been supported through any research I have read; if someone can point to that research, I would greatly appreciate it. Specifically nasal regurgitation with reflux or bolus left in the nasal passage to develop an infection would result in runny nose. Spicey foods and passage of the FEES flexible scope can result in runny nose and watering eyes, and extreme coughing can result in both; however, in over 30 years of dysphagia dx and tx, I have never had a patient demonstrate either of these symptoms when I have seen frank aspiration during an MBS.
If there is research out there, please point me in that direction!
Much appreciated!!

Kate Connell,  Dir of RehabFebruary 06, 2014
Fort Collins, CO




     

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