Scary Swallowing Problems May Have a Medical Reason Behind Them

EDITOR’S NOTE: This content has been provided to Assisting Hands Home Care by Fox Rehabilitation and was originally published on their blog and has been updated by Assisting Hands Home Care Monmouth. We thought it contained valuable information and obtained permission to share it as a resource.

By Rene Jablonski, MA, CCC-SLP, speech-language pathologist, Fox Rehabilitation

Who does not love to eat? Food is central to our lives in so many ways: sustenance for our bodies, comfort in times of need and a catalyst for so many happy gatherings with friends and families.

The simple act of sitting at the table and eating a meal can be stressful for many. Every time they do this, they can cough, choke, have a runny nose and watery eyes. It is not an allergy attack; it is a difficulty swallowing food.

The official medical term for this is dysphagia. It is a complicated, scary-sounding word and can be terrifying to watch as someone struggles to eat.

Dysphagia creates difficulty manipulating and swallowing food and drinks safely and can have significant impacts on overall health and quality of life, according to the Mayo Clinic. The disorder includes problems involving the oral cavity, pharynx, esophagus, or gastroesophageal junction, according to the American Speech-Language-Hearing Association.

A person with dysphagia probably stresses out about eating/drinking. They can start to lose weight, stop eating foods they love, and turn down socialization opportunities that involve eating due to this anxiety.

More than 60,000 Americans die each year due to complications associated with dysphagia, including aspiration pneumonia, according to the Agency for Health Care Policy and Research.

What are the different stages of dysphagia?

Let us discuss and clear the air about what exactly is dysphagia. Dysphagia can be broken down into four different phases: the oral preparatory stage, the oral stage, the pharyngeal stage, and the esophageal stage.

The oral preparatory stage includes chewing, mixing the food with saliva. It also includes the orientation of feeding utensils, how the person takes the food off the utensil or accepts the liquids from a cup.

The oral stage includes the act of taking the masticated food and mixing it with saliva to create a bolus. The tongue then moves the bolus back toward the back of the oral cavity.

The pharyngeal stage occurs when the vocal folds close to keep food and liquids from entering the airway. The larynx rises inside the neck and the epiglottis moves down to cover the airway, providing even more airway protection. The pharyngeal stage starts the swallow and squeezes the food down the throat. You need to close off your airway in order to keep food or liquid out and prevent penetration/aspiration.

The esophageal stage includes the bolus moving into the esophagus, the muscular tube that contracts to push the bolus into the stomach.

In this phase, the bolus is propelled downward by a peristaltic movement. The lower esophageal sphincter relaxes at the initiation of the swallow, and this relaxation persists until the food bolus has been propelled downward by a peristaltic movement. The lower esophageal sphincter relaxes at the initiation of the swallow, and this relaxation persists until the food bolus has been propelled into the stomach.

If the esophageal stage is affected, the patient might experience heartburn, vomiting, burping, or abdominal pain.

As a result of any of this dysphagia, there is an increased risk of aspiration. This is when food and fluid enter the airways below the true vocal folds which can result in aspiration pneumonia. Therefore, the use of modified diets is utilized to try to prevent aspiration and its consequences in those with dysphagia.

Living with Dysphagia

Speech-language pathologists can assess and help people with dysphagia cope with the biomechanical swallowing effects of the disease and teach techniques on how to eat. These professionals have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract—including oral, pharyngeal, and cervical esophageal anatomic regions—for swallowing and speech.

Dysphagia interventions include medical, surgical, and behavioral treatment and a speech-language pathologist can help determine the best course of action.