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When something goes wrong with the muscles that direct swallowing, it’s called dysphagia.
Dysphagia can lead to food or other material entering the airways or lungs. This is called aspiration. Normally, a flap called the epiglottis blocks food particles and stomach contents from entering your lungs. Dysphagia can disrupt this process. Aspiration is serious because it can lead to pneumonia and other problems.
Problems with any of the phases of swallowing can cause dysphagia.
You normally swallow hundreds of times a day without even thinking about it. You swallow foods, liquids, and the normal saliva and mucus that your body makes.
When you swallow food, it passes through your mouth and into a part of your throat called the pharynx. From here, the food passes through a long tube (the esophagus) before entering your stomach and the rest of your gastrointestinal tract. This requires a series of actions from the muscles along the path. It also requires coordination with the muscles of breathing. Breathing pauses when you swallow.
Swallowing is a very complex process. It requires the coordination of several nerves and muscle groups. Doctors describe it in three phases:
The last two phases are not under conscious control.
Several conditions can lead to swallowing problems. Some examples are:
Trouble with different phases of swallowing may mean different sorts of medical problems. For example, decreased saliva is likely to cause a problem with the oral preparatory phase of swallowing. Parkinson disease might cause problems with the pharyngeal phase. A blockage in the esophagus would likely cause problems with the esophageal phase.
Dysphagia and aspiration might cause some of the following symptoms:
Your symptoms may partly depend on the phase of your swallow that is affected.
If you have symptoms of dysphagia or aspiration, you need to be checked right away. If you have a condition, such as stroke, that can cause trouble swallowing, you will need to be evaluated for dysphagia.
Diagnosis usually begins with a health history and evaluation. This is often done by a speech-language pathologist (SLP). The SLP may begin by asking you about symptoms that might be related to dysphagia. He or she usually asks questions about the kinds of things that give you problems and about the timing of your symptoms.
The SLP will also look at your teeth, lips, jaws, tongue, and cheeks. You may need to move these areas in certain ways and make certain sounds. Your SLP may also check how you swallow different consistencies of liquids and foods. All of this is to help determine what phase of swallowing might be causing your problems. It can also give clues about the underlying cause for your dysphagia.
In some cases, you might need follow-up testing to find the source of your dysphagia. These tests can also help find the phase of swallowing that is causing the problems. These might include:
If possible, your medical team tries to address the underlying cause of dysphagia. In certain cases, you may need surgery to treat the root cause. You also may be able to take medicines to reduce the flow of saliva to address a cause of your dysphagia.
The symptoms of dysphagia also need to be managed. Depending on the specific type of your dysphagia, this might include:
As you recover, you might need to use fewer of these steps. Dysphagia after a stroke may greatly improve with time.
Some people are at high risk of aspiration even with these changes. If this is the case for you, you might need a feeding tube to prevent aspiration, at least temporarily.
A major complication of dysphagia is lung damage from aspiration.
Aspiration also increases your chance of getting pneumonia. This usually needs treatment with antibiotics. It can sometimes even causes death. With dysphagia, aspiration is always a risk.
Other possible complications include:
Tips to help you get the most from a visit to your healthcare provider:
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