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You’ve probably heard, ‘I’m okay, it just went down the wrong pipe,’ paired with coughing for the next few minutes. All of us have difficulty swallowing once in a while, but how do you know if your swallowing is appropriate or not? And why does it matter if you’re swallowing accurately? Keep reading to find out. What are signs of problematic swallowing? Coughing As mentioned before, it is normal to cough once in a while when you swallow. However, if you are finding yourself coughing a lot when you eat or drink, this may be a sign that you are experiencing an irregular swallow. Throat Clearing Gurgly Voice Pain When Swallowing *There are more signs and symptoms of an errored swallow than listed above. These are a few of many. Please see the American Speech-Language-Hearing Association website for more information. https://www.asha.org/public/speech/swallowing/swallowing-disorders-in-adults/ Food and water are supposed to go down the esophagus and into the stomach. However, when food ‘goes down the wrong pipe,’ it is entering the airway. This gives food and water the opportunity to get into the lungs. If food or water gets into the lungs, this can cause aspiration pneumonia. Aspiration pneumonia can lead to hospitalization. If you believe that you are experiencing an abnormal swallow, see a Speech-Language Pathologist. Speech-Language Pathologists can identify if there is a problem and how to support a health, safe swallow.
Most swallowing problems can be treated, although the treatment you receive will depend on the type of dysphagia you have. Treatment will depend on whether your swallowing problem is in the mouth or throat (oropharyngeal, or "high" dysphagia), or in the oesophagus (oesophageal, or "low" dysphagia). The cause of dysphagia is also considered when deciding on treatment. In some cases, treating the underlying cause, such as mouth cancer or oesophageal cancer, can help relieve swallowing problems. Treatment for dysphagia may be managed by a group of specialists known as a multidisciplinary team (MDT). Your MDT may include a speech and language therapist (SLT), a surgeon, and a dietitian. High (oropharyngeal) dysphagiaHigh dysphagia is swallowing difficulties caused by problems with the mouth or throat. It can be difficult to treat if it's caused by a condition that affects the nervous system. This is because these problems can't usually be corrected using medication or surgery. There are 3 main treatments for high dysphagia:
Swallowing therapyYou may be referred to a speech and language therapist (SLT) for swallowing therapy if you have high dysphagia. An SLT is a healthcare professional trained to work with people with feeding or swallowing difficulties. SLTs use a range of techniques that can be tailored for your specific problem, such as teaching you swallowing exercises. Dietary changesYou may be referred to a dietitian (specialist in nutrition) for advice about changes to your diet to make sure you receive a healthy, balanced diet. An SLT can give you advice about softer foods and thickened fluids that you may find easier to swallow. They may also try to ensure you're getting the support you need at meal times. Feeding tubesFeeding tubes can be used to provide nutrition while you're recovering your ability to swallow. They may also be required in severe cases of dysphagia that put you at risk of malnutrition and dehydration. A feeding tube can also make it easier for you to take the medication you may need for other conditions. There are 2 types of feeding tubes:
Nasogastric tubes are designed for short-term use. The tube will need to be replaced and swapped to the other nostril after about a month. PEG tubes are designed for long-term use and last several months before they need to be replaced. Most people with dysphagia prefer to use a PEG tube because it can be hidden under clothing. However, they carry a greater risk of complications compared with nasogastric tubes. Minor complications of PEG tubes include tube displacement, skin infection, and a blocked or leaking tube. 2 major complications of PEG tubes are infection and internal bleeding. Resuming normal feeding may be more difficult with a PEG tube compared with using a nasogastric tube. The convenience of PEG tubes can make people less willing to carry out swallowing exercises and dietary changes than those who use nasogastric tubes. You should discuss the pros and cons of both types of feeding tubes with your treatment team. Low (oesophageal) dysphagiaLow dysphagia is swallowing difficulties caused by problems with the oesophagus. MedicationDepending on the cause of low dysphagia, it may be possible to treat it with medication. For example, proton pump inhibitors (PPIs) used to treat indigestion may improve symptoms caused by narrowing or scarring of the oesophagus. Botulinum toxinBotulinum toxin can sometimes be used to treat achalasia. This is a condition where the muscles in the oesophagus become too stiff to allow food and liquid to enter the stomach. It can be used to paralyse the tightened muscles that prevent food from reaching the stomach. However, the effects only last for around 6 months. SurgeryOther cases of low dysphagia can usually be treated with surgery. Endoscopic dilatationEndoscopic dilation is widely used to treat dysphagia caused by obstruction. It can also be used to stretch your oesophagus if it's scarred. Endoscopic dilatation will be carried out during an internal examination of your oesophagus (gastroscopy) using an endoscopy. An endoscope is passed down your throat and into your oesophagus, and images of the inside of your body are transmitted to a television screen. Using the image as guidance, a small balloon or a bougie (a thin, flexible medical instrument) is passed through the narrowed part of your oesophagus to widen it. If a balloon is used, it will be gradually inflated to widen your oesophagus before being deflated and removed. You may be given a mild sedative before the procedure to relax you. There's a small risk that the procedure could cause a tear or perforate your oesophagus. Find out more about gastroscopy. Inserting a stentIf you have oesophageal cancer that can't be removed, it's usually recommended that you have a stent inserted instead of endoscopic dilatation. This is because, if you have cancer, there's a higher risk of perforating your oesophagus if it's stretched. A stent (usually a metal mesh tube) is inserted into your oesophagus during an endoscopy or under X-ray guidance. The stent then gradually expands to create a passage wide enough to allow food to pass through. You'll need to follow a particular diet to keep the stent open without having blockages. Congenital dysphagiaIf your baby is born with difficulty swallowing (congenital dysphagia), their treatment will depend on the cause. Cerebral palsyDysphagia caused by cerebral palsy can be treated with speech and language therapy. Your child will be taught how to swallow, how to adjust the type of food they eat, and how to use feeding tubes. Cleft lip and palateCleft lip and palate is a facial birth defect that can cause dysphagia. It's usually treated with surgery. Narrowing of the oesophagusNarrowing of the oesophagus may be treated with a type of surgery called dilatation to widen the oesophagus. Gastro-oesophageal reflux disease (GORD)Dysphagia caused by gastro-oesophageal reflux disease (GORD) can be treated using special thickened feeds instead of your usual breast or formula milk. Sometimes medication may also be used. Breastfeeding or bottle feedingIf you're having difficulty bottle feeding or breastfeeding your baby, see your midwife, health visitor or GP Aspiration is when something enters your airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. Aspiration can happen when you have trouble swallowing normally. This is called dysphagia. When you swallow food, it passes from your mouth down into your throat. This is called the pharynx. From there, the food moves down through a long tube (the esophagus) and into your stomach. This journey is made possible by a series of actions from the muscles in these areas. Dysphagia happens when there is a disruption in the swallowing process as food and liquids pass through your mouth, throat, and esophagus. The pharynx is also part of the system that brings air into your lungs. When you breathe, air enters your mouth and moves into the pharynx. The air then goes down into your main airway (trachea) and into your lungs. A flap of tissue called (the epiglottis) sits over the top of the trachea. This flap blocks food and drink from going down into the trachea when you swallow. But in some cases, food or drink can enter the trachea. It may go down as you swallow. Or it may come back up from the stomach. A person with dysphagia is much more likely to aspirate. Dysphagia is more common in older adults. Stroke is a very common cause of both dysphagia and aspiration. About 50% of people who have had a stroke also have dysphagia. About 50% of people with dysphagia have aspiration. About one-third of these people will need treatment for pneumonia at some point. What causes aspiration from dysphagia?Aspiration from dysphagia is caused when the muscles in the throat don't work normally. This lets food or drink enter the trachea when you swallow. This can happen as food goes down when you swallow. Or it can happen if food comes back up from your stomach. What are the risks for aspiration from dysphagia?When a person has dysphagia, aspiration is always a risk. You may be at risk for aspiration from dysphagia if you have any of these medical conditions:
What are the signs and symptoms of dysphagia and aspiration from dysphagia?Aspiration from dysphagia can cause signs and symptoms such as:
Signs and symptoms can happen right after eating. Or they may happen over time. You may not have all of these signs and symptoms. Your signs and symptoms may depend on how often and how much food or drink you aspirate. Some people who aspirate do not have any signs or symptoms. This is called silent aspiration. How is aspiration from dysphagia diagnosed?You will need to be checked for aspiration from dysphagia if you have signs or symptoms. You may also need to be checked if you have had a stroke or other health problem that can cause trouble swallowing. If your healthcare provider thinks you may be aspirating, you may be told to not eat or drink until you are tested. Your healthcare provider will ask about your medical history and symptoms. This may be done by a speech-language pathologist (SLP). The SLP will try to find out if you have problems with the lower or upper part of your swallowing muscles. The SLP may ask about what foods or drink cause problems, and when your symptoms occur. You may have a physical exam. This may include an exam of your teeth, lips, jaws, tongue, and cheeks. You may be asked to move these areas in certain ways and make certain sounds. Your SLP may also test how you swallow different types of liquids and solids. You may also need 1 or more tests. These can help to find the cause of your dysphagia. Tests are often very helpful in showing cases of silent aspiration. The test may include:
How is aspiration from dysphagia treated?Your healthcare provider will try to treat the cause of your dysphagia. This may include using medicines. In some cases, surgery may be able to treat the cause of dysphagia. The symptoms of dysphagia also need to be managed. This may include doing things such as:
As you recover, you may need to use fewer of these methods. Dysphagia after a stroke may improve greatly over time. You may still be at high risk of aspiration even with these methods. If this is the case, you may need to use a feeding tube for a period of time to prevent aspiration. What are the complications of aspiration from dysphagia?A major complication of aspiration is harm to the lungs. When food, drink, or stomach contents make their way into your lungs, they can damage the tissues there. The damage can sometimes be severe. Aspiration also increases your risk of pneumonia. This is an infection of the lungs that causes fluid to build up in the lungs. Pneumonia needs to be treated with antibiotics. In some cases, it may cause death. Other possible complications from dysphagia include:
These problems can reduce your level of independence. They may also cause or lengthen a stay in the hospital. What can I do to prevent aspiration from dysphagia?You can reduce your risk of aspiration by:
When should I call my healthcare provider?Tell your healthcare provider right away if you think you may have a problem with dysphagia or aspiration. It should be treated as soon as possible. Key points
Next stepsTips to help you get the most from a visit to your healthcare provider:
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