Swallowing Disorders (Dysphagia) in Adults
What are swallowing disorders?
Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
- Oral phase – sucking, chewing, and moving food or liquid into the throat
- Pharyngeal phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
- Esophageal phase – relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach
What are some signs or symptoms of swallowing disorders?
Several diseases, conditions, or surgical interventions can result in swallowing problems.
General signs may include:
- coughing during or right after eating or drinking
- wet or gurgly sounding voice during or after eating or drinking
- extra effort or time needed to chew or swallow
- food or liquid leaking from the mouth or getting stuck in the mouth
- recurring pneumonia or chest congestion after eating
- weight loss or dehydration from not being able to eat enough
As a result, adults may have:
- poor nutrition or dehydration
- risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
- less enjoyment of eating or drinking
- embarrassment or isolation in social situations involving eating
How are swallowing disorders diagnosed?
A speech-language pathologist (SLP) who specializes in swallowing disorders can evaluate individuals who are experiencing problems eating and drinking. The SLP will
- take a careful history of medical conditions and symptoms
- look at the strength and movement of the muscles involved in swallowing
- observe feeding to see posture, behavior, and oral movements during eating and drinking
- possibly perform special tests to evaluate swallowing, such as
- modified barium swallow – individual eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray
- endoscopic assessment – a lighted scope is inserted through the nose, and then the swallow can be viewed on a screen
What treatments are available for people with swallowing disorders?
Treatment depends on the cause, symptoms, and type of swallowing problem.
A speech-language pathologist may recommend:
- specific swallowing treatment (e.g., exercises to improve muscle movement)
- positions or strategies to help the individual swallow more effectively
- specific food and liquid textures that are easier and safer to swallow
After the evaluation, family members or caregivers can help by:
- asking questions to understand the problem and the recommended treatment
- assisting in following the treatment plan:
- help with exercises
- prepare the recommended textures of food and liquid, making sure that recommendations for eating safely are followed
- keep track of how much food or liquid is consumed
What other organizations have information about swallowing disorders?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.
What causes swallowing disorders in adults?
Some causes of feeding and swallowing problems in adults are:
Damage to the nervous system, such as:
- brain injury
- spinal cord injury
- Parkinson's disease
- multiple sclerosis
- amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
- muscular dystrophy
- cerebral palsy
- Alzheimer's disease
Problems affecting the head and neck, including:
- cancer in the mouth, throat, or esophagus
- injury or surgery involving the head and neck
- decayed or missing teeth, or poorly fitting dentures
How effective are treatments for swallowing disorders in adults?
ASHA produced a treatment efficacy summary on swallowing disorders [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with swallowing disorders and their caregivers but also to insurance companies considering payment for much needed services for swallowing disorders in adults.
What does a speech-language pathologist do when working with adults with swallowing disorders?
It is ASHA's position that "speech-language pathologists play a primary role in the evaluation and treatment of infants, children, and adults with swallowing and feeding disorders."
ASHA has developed a number of documents about the role of the SLP in working with individuals with swallowing disorders. These include the following:
In addition, documents about the role of the SLP in videofluoroscopy and endoscopic evaluations of swallowing exist. These documents include the following:
The Preferred Practice Patterns for the Profession of Speech-Language Pathology outline the common practices followed by SLPs when engaging in various aspects of the profession. The Preferred Practice Patterns for swallowing and feeding assessment and intervention for adults are outlined in Sections 42 and 43.