Swallowing Problems (Dysphagia) in Adults

About Dysphagia

Dysphagia means that you have problems with swallowing. This could mean problems with using the mouth, lips, and tongue to control food or liquid. It could also mean problems in the throat during swallowing. It may be caused by differences in strength, coordination, sensation or timing of the muscles and nerves used to swallow. Dysphagia causes concern because it may affect your health and nutrition.

Signs and Symptoms of Dysphagia

• Problems coordinating swallowing and breathing while eating or drinking.

• Coughing

• Choking

• Gagging or vomiting.

• Trouble chewing.

• Gurgling voice or weaker voice.

• Changes in your lungs and breathing after eating or drinking.

• History of pneumonia.

• Feeling of food being stuck in your throat.

• Food staying in your mouth after you swallow.

• Limited intake of food or liquids.

• Refusing foods or liquids that were eaten before.

• Losing weight related to swallowing problems.

• Food or liquid in a tracheostomy tube during or after eating.
  

Possible Problems of Dysphagia

You may have problems because of your swallowing issues. This could include food or liquid getting into the lungs. This is called aspiration. Other problems could include:

• Poor nutrition and weight loss.

• Dehydration

• More risk for choking or illness.

• Frequent respiratory (lung) illnesses/ infections like pneumonia.

• Not able to manage food or liquids.

• Not able to chew or control food or liquids in the mouth.

• Not able to eat/drink what would be expected for a child of the same age.

• Anxiety about eating/drinking.

• Longer hospital stays.
  

How Dysphagia Is Diagnosed

If your doctors or nurses think you have a swallowing problem, they will ask a swallow specialist to check your swallow.

Clinical Swallow Test

A licensed speech-language pathologist (SLP) will come to your room to test your swallowing. You will sit upright in your bed or in a chair. They will check to see if you are able to swallow water, semi-solid and solid foods. They may feel your neck while you swallow. While you swallow, the specialist will watch and listen for signs of problems. If the SLP notices these signs, they may do one of the tests below.

Video fluoroscopic Swallow Study (VFSS)

You will go to the Radiology Department for this test. During this test, you will swallow barium liquids, semi-solid and solid foods, and possibly pills. While you swallow, a video x-ray will be taken of your mouth and throat to see if and where you are having problems.

Fiberoptic Endoscopic Evaluation of Swallow (FEES)

This test is done at the bedside or in clinic by a swallow specialist. You will sit upright in your bed or a chair for this test. A small camera called an endoscope will slide through your nose. This will allow the therapist to look at your throat and watch where the food and liquid are going when you swallow.

These tests will show if and where you are having trouble. If you have a swallow problem, the specialist will tell you the type of diet and fluid textures you need as well as the best way to take your medicine.

Sometimes a person may not be able to eat any food or drink liquids because of the high risk of them going into the lungs.

Prescribed Diet

Diet changes can make it easier and safer for you to swallow. This could mean different food textures and/or thicker liquids. You may be prescribed a different solid diet type and/or different liquid texture from the lists below.

Different Solid Diets

• No solids

• Pureed: smooth textures with no lumps, no chewing ability needed, can be eaten by spoon.

• Minced and Moist: 1/8 inch (4 mm) cubes, minimal chewing needed.

• Soft/Bite-sized: bite-sized ½ inch (1.5 cm) pieces, tender and moist throughout, with no thin liquid leaking or dripping from the food. (Must be able to chew)

• Easy to chew: soft/tender everyday food textures that require biting and chewing ability.

• Regular: normal diet
  

Different Liquid Textures

• No liquids

• Moderately thick liquids (comparable to honey)

• Mildly thick liquids (comparable to nectar)

• Thin liquids: regular liquids
  

Supervised Eating and Drinking

You may need to have someone with you while you eat. This is to make sure you are swallowing okay. This could mean:

• 1:1 supervision: constant watching.

• Intermittent: checking on you often.

• Independent: you can eat on your own.
  

Taking Medicine

Medicine may need to be given in a special way. You may need:

• Only liquid medicine

• Crushed in puree

• Whole in puree

• Whole with thick liquids

• Whole with thin liquids
  

Ways to Make Swallowing Safer

You may need to use special ways to help the food and liquids go into the stomach. There may be positions or feeding methods that help foods or liquids to move safely past your windpipe. The SLP will know if you need exercises to help strengthen the muscles you use to swallow, based on the results of the tests. The specialist and care team will write a plan to manage your swallow problems before you leave the hospital. The SLP may also make a plan for ongoing services after leaving the hospital.

Your doctor and speech pathologist should help you to decide if further changes are needed. Another swallow study may be needed before any changes are made.

When to Call

Reasons to call many include:

• More trouble swallowing

• More coughing

• Choking

• Weight loss

• More congestion with eating/drinking or shortly after a meal

• Fevers (100.5◦F or higher)
  

Who to Call

Call your primary care doctor for urgent medical questions. Ask your doctor to help you contact an outpatient Speech Language Pathologist.