Swallowing Disorders & Its Stages

What is swallowing?

Swallowing, also called Deglutition, the act of passing food from the mouth, by way of the pharynx (or throat) and esophagus, to the stomach. Four phases are involved in swallowing food.

What is Dysphagia:

The global definition of dysphagia is simply “difficulty in swallowing.” Dysphagia may also include such problems as foods or liquids “sticking” in the throat or regurgitation of swallowed liquids or foods.

Incidence and Prevalence:

It is estimated that in the United States alone, 300,000 to 600,000 people with clinically significant dysphagia are diagnosed annually. The true incidence of dysphagia may not be known, as it is often a condition following a primary diagnosis. dysphagia can be listed as a secondary diagnosis following a stroke.

Phases of swallowing:

The phases of the swallowing are oral preparatory, oral, pharyngeal, and esophageal.

Epidemiology:

Dysphagia can be caused by many different disorders, including natural aging, neurologic diseases,

head injury, degenerative diseases, systemic diseases, autoimmune disorder, and infections

Signs and Symptoms of Dysphagia

Oral Preparatory: Lip weakness and Leakage of food through lips

Oral: Pocketing of food in buccal cavity

Pharyngeal: Multiple times swallowing, Takes more time in initiating swallowing, Clearing of throat, change in voice after swallow

Esophageal: Delayed aspiration

Important terms:

Penetration: is defined as the entry of food contents into the larynx (not beyond vocal cords)

Aspiration: is the entry of food material into the airway below the vocal cords

Aspiration pneumonia: is a condition resulting from the entrance of food contents into the lungs which can result into aspiration

Conditions High-Risk for Aspiration Pneumonia:

How to assess Dysphagia

A dysphagia assessment is usually carried out by a speech and language pathologist (SLP)

Oral, Pharyngeal and Laryngeal examinations should be conducted for swallowing assessment

Instrumental Assessment of Swallowing:

1) Flexible endoscopic evaluation of swallowing (FEES):

FEES test is a procedure used to assess how well you swallow. During the procedure, a speech-language pathologist (SLP) passes a thin, flexible instrument (endoscopy) through your nose. Then the SLP views parts of your throat during swallowing.

2) Videofluoroscopic swallow study (VFSS)

VFSS is the standard imaging method used for diagnosing and managing oropharyngeal dysphagia, allowing for evaluation of the oral, palatal, pharyngeal, and pharyngoesophageal segments of deglutition.

It is also useful in identifying aspiration risk in patients with dysphagia

How to treat dysphagia:

The treatment process of dysphagia involves multiple health professionals (includes SLP, Occupational therapist, Physiotherapist, Dietitian, Dentist and Nurse) and initially focuses on swallow safety.

The prevention of aspiration and maintaining good swallowing-related quality of life are the main objectives of most treatment methods.

The major treatment methods for dysphagia includes:

•  Compensatory swallowing therapy

•  Rehabilitative swallowing therapy

Compensatory swallowing therapy

Compensatory swallowing therapy refers to strategies that aim to ensure safe swallows without directly changing any of the swallowing physiology (effectiveness should be assessed under instrumental evaluation)

It includes:

1. Supraglottic swallow

2. Super-supraglottic swallow

3. Effortful swallow

4. Mendelsohn maneuver

5. Tongue hold maneuver

Other treatment options:

Electrical Stimulation

Neuromuscular electrical stimulation (NMES) is a technique that has been proposed to stimulate swallow function by applying electrical stimulation to the neck area by stimulating the muscles in the neck via electrodes, it improves the strength of swallowing muscles.