Difficulty Swallowing

The ability to swallow is something we never think about until something changes and it becomes painful or difficult to swallow. The medical term for this condition is dysphagia. Some common symptoms are coughing during and after eating or drinking, throat clearing, a wet sounding voice, a sensation that food is sticking in the throat, food or liquid is leaking from the mouth or remaining in the mouth after swallowing, and excess time and effort is needed to chew or swallow.

Being able to swallow is something everyone assumes will naturally occur and we swallow without ever thinking about how the process of swallowing occurs.  Actually, approximately 50 pairs of muscles and thousands of nerves are involved in the process of transporting the food and drinks we consume from our mouth to our stomach. There are three stages involved in the swallowing process. The oral stage is when the food we consume is chewed and the tongue squeezes it into the back of the throat (or pharynx). The second stage, known as the pharyngeal stage, begins as the bolus of food enters the back of the throat and an involuntary response stimulates the closure of the larynx by the epiglottis and the vocal folds. This prevents the food from going “down the wrong pipe” into the trachea and the lungs. As food leaves the pharynx, it enters the esophageal stage. The esophagus is a tube-like muscular structure which leads food into the stomach due to its rhythmic contractions. Dysphagia can occur at any of the three stages of the swallowing process.

Our team of licensed speech-language pathologists provide speech therapy for swallowing disorders. An evaluation for speech therapy for dysphagia consists of collecting the history of medical conditions, symptoms and the review of current medications. During the evaluation, an assessment of the strength, movement and coordination of the muscles involved in swallowing will be performed as well as observation of posture, behaviors, and oral movements during eating and drinking. Tests that further evaluate swallowing such as a Modified Barium Swallow (involves eating and drinking foods and liquid with barium in it and then the swallowing process is visible on an X-ray) or Fiberoptic Endoscopic Evaluation of Swallowing also called a FEES assessment (a lighted scope is inserted through the nose, and then the swallowing of foods and liquids is viewed on a monitor) may be recommended.  Speech therapy for dysphagia includes exercises to improve the function of the muscles involved in swallowing, the implementation of positions or strategies that will improve the ability to swallow effectively, and recommended diet textures that are safer to swallow.

An individualized speech therapy care plan is created for each patient. Therapy regimens usually consist of a weekly therapy sessions and home exercises. In office speech therapy for dysphagia may consist of exercises using the IOPI system to improve lip and tongue strength as well as endurance. Therapy sessions may also involve resistive exercises paired with neuromuscular electrical stimulation to re-educate the muscles involved in swallowing. Patients typically report a significant recovery that results from increased awareness and carryover of recommended exercises and techniques that lead to a resolution of symptoms.

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