Swallowing disorders, also called dysphagia, can occur in one or more of the four phases of swallowing and can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity. Four stages of swallowing:
- Oral Preparatory—voluntary phase during which food or liquid is manipulated in the mouth to form a cohesive bolus—includes sucking liquids, manipulating soft boluses, and chewing solid food.
- Oral Transit—voluntary phase that begins with the posterior propulsion of the bolus by the tongue and ends with initiation of the pharyngeal swallow.
- Pharyngeal—begins with the initiation of a voluntary pharyngeal swallow which in turn propels the bolus through the pharynx via involuntary peristaltic contraction of the pharyngeal constrictors.
- Esophageal—involuntary phase during which the bolus is carried to the stomach through the process of esophageal peristalsis
Several diseases, conditions, or surgical interventions can result in swallowing problems.
General signs may include:
- drooling and poor oral management of secretions and/or bolus
- ineffective chewing, in consideration of the individual variability in mastication cycles and time (Shiga et al., 2012)
- food or liquid remaining in the oral cavity after the swallow (oral residue)
- inability to maintain lip closure, leading to food and/or liquids leaking from the oral cavity (anterior loss of bolus)
- extra time needed to chew or swallow
- food and/or liquids leaking from the nasal cavity (nasopharyngeal regurgitation)
- complaints of food “sticking” or complaints of a “fullness” in the neck (globus sensation)
- complaints of pain when swallowing (odynophagia)
- changes in vocal quality (e.g., wet or gurgly sounding voice) during or after eating or drinking
- coughing or throat clearing during or after eating or drinking
- difficulty coordinating breathing and swallowing
- acute or recurring aspiration pneumonia/respiratory infection and/or fever (Bock et al., 2017; DiBardino & Wunderink, 2015; Marik, 2010)
- changes in eating habits, for example, avoidance of certain foods/drinks (Sura et al., 2012)
- weight loss, malnutrition, or dehydration from not being able to eat enough (Saito et al., 2017; Via & Mechanick, 2013)
- complaints of discomfort related to suspected esophageal dysphagia (e.g., globus sensation, regurgitation)
- Crying during mealtimes (for children)
- Decreased responsiveness during feeding
- Disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from food source
(Adult Dysphagia, n.d.; Pediatric Dysphagia, n.d.)
Treatment
The primary goals of dysphagia intervention for adults are to
- support adequate nutrition and hydration and return to oral intake (including incorporating the patient’s dietary preferences and consulting with family members/caregivers to ensure that the patient’s daily living activities are being considered)
- determine the optimum supports (e.g., posture, or assistance) to reduce patient and caregiver burden while maximizing the patient’s quality of life
- develop a treatment plan to improve the safety and efficiency of the swallow.
The primary goals of feeding and swallowing intervention for children are to
- support safe and adequate nutrition and hydration
- determine the optimum feeding methods and techniques to maximize swallowing safety and feeding efficiency
- collaborate with family to incorporate dietary preferences
- attain age-appropriate eating skills in the most normal setting and manner possible (i.e., eating meals with peers in the preschool, meal time with family)
- minimize the risk of pulmonary complications
- maximize the quality of life
- prevent future feeding issues with positive feeding-related experiences to the extent possible, given the child’s medical situation.
(Adult Dysphagia, n.d.; Pediatric Dysphagia, n.d.)
Additional Resources
ASHA: Adult Feeding & Swallowing
ASHA: Pediatric Feeding & Swallowing
References
American Speech-Language-Hearing Association. (n.d.). Adult Dysphagia. (Practice Portal). Retrieved November 15, 2021, from www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/
American Speech-Language-Hearing Association. (n.d). Pediatric Dysphagia. (Practice Portal). Retrieved November 15, 2021, from www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/