By Cathy Lazarus, Ph.D., CCC-SLP
The act of swallowing is fairly effortless and something we rarely think about. We swallow our saliva about once a minute during the day. Swallowing impairment, or “dysphagia”, can have a devastating impact on our lives. Inability to eat or drink can cause isolation, since we frequently socialize over meals or drinks. Dysphagia can also have a health impact, since difficulty swallowing can result in pneumonia if what we eat or drink goes into our lungs. Swallowing impairment can occur after stroke, with impairment in muscle functioning needed to manipulate foods and liquids in the mouth, through the pharynx (i.e., throat) and into the esophagus. Dysphagia can also occur with progressive neurologic disease, such as ALS, Parkinson’s disease, and multiple sclerosis, as well as traumatic brain injury. Some people develop swallowing problems because they have become weak due to a medical illness or hospitalization. This overall deconditioning can cause a weaker swallow that may need to be addressed.
Individuals with head and neck cancer of the lip, tongue, palate, larynx, pharynx or esophagus can also experience swallowing impairment. Treatment of head and neck cancer can include surgery with chemoradiotherapy or chemoradiotherapy alone. Although treatment can cure the disease, individuals can experience difficulty swallowing afterwards, since structures and muscles involved in swallowing are often removed with surgery or become stiffer after radiotherapy. Surgeons and medical and radiation oncologists are currently developing newer surgical techniques and radiation treatments to reduce side effects, improve swallowing outcomes and overall quality of life.
Certified and licensed speech-language pathologists are educated and trained in normal anatomy and physiology of swallowing, as well as abnormal swallowing. Their training also includes evaluation and treatment of swallowing disorders. The clinical assessment is typically employed to determine whether an individual has a swallowing impairment. This assessment includes obtaining a history of the problem, performing an examination of muscle functioning for swallowing and performing a hands-on clinical assessment of swallowing. Once a problem has been identified, the speech-language pathologist typically performs a diagnostic exam utilizing instrumental assessment techniques. This can include an x-ray evaluation, or videofluoroscopic swallow study (i.e., Modified Barium Swallow Test) which views the swallowing structures as well as what is being swallowing. The individual is sitting upright while swallowing various volumes and consistencies, including liquids, pudding and chewable consistencies. Once the swallowing impairment is identified by the speech-language pathologist and radiologist, the speech-language pathologist can assess various therapeutic strategies in x-ray to determine the effectiveness, resulting in a safer and more efficient swallow. Another technique for assessing swallowing is Flexible Endoscopic Evaluation of Swallowing (FEES). The speech-language pathologist passes an endoscope (ie., flexible scope) through the nose into the pharynx to view the swallowing mechanism while foods and liquids are swallowed. Therapeutic strategies can also be introduced with this exam.
After the specific swallowing impairment has been identified, the speech-language pathologist provides therapy to improve swallowing. This typically involves strengthening muscles that are involved in swallowing and may involve instruction in swallowing maneuvers that modify the swallow to improve its safety and efficiency. The speech-language pathologist also works with the physician, as some individuals need medical management of their swallowing problem or may also need further work-up, particularly of the esophagus.
If you or someone you know has a swallowing problem, search for a certified, licensed speech-language pathologist on our website, who can evaluate your swallowing and identify best management strategies.