Take a moment to picture those activities you enjoy the most in life. Many of them are likely centered around eating, enjoying favorite foods, or gathering with friends and loved ones for events and occasions that involve special meals. Most of us have never stopped to consider the complex neurological and motor activities that make these experiences possible.
Many have experienced occasional coughing when something we eat or drink goes “down the wrong tube”. This may happen if we eat or drink something too quickly, are not paying attention, or perhaps while we are laughing when trying to swallow. When this occurs with any regularity, it can be a sign of dysphagia, a broad term to describe a swallowing problem.
To help deepen our understanding of swallowing difficulties, we spoke with Dr. Jessica Galgano, executive director and founder of Open Lines Speech and Communication and her team at Open Lines Speech and Communication. Dr. Galgano and the team gave us insight on what causes dysphagia, what can happen if it goes untreated, and how speech therapy can help improve your symptoms.
Muscles Involved in Swallowing
Swallowing is considered a sensorimotor activity, explained Dr. Galgano. It involves muscle activation and coordination to manage and swallow food or liquid, and at the same time, integrates sensory information, such as taste, texture, size, and temperature of the liquid or food in your mouth. This information is sent to your brain, which helps your body determine exactly how your muscles should respond with appropriate force, coordination, and timing for a safe swallow.
The act of swallowing requires precise and efficient coordination of many systems of muscles located throughout the face, mouth, and throat, as well as those responsible for respiration.
Take this real-life example of eating an apple. As you begin to chew in the oral stage of the swallow, your jaw muscles engage and your lips activate to stay closed to prevent food from spilling out and form a food bolus.
Your cheeks help keep the masticated (chewed) food in the right places while you chew. At the same time, your tongue manipulates the food throughout the oral cavity to ensure it is the proper consistency to swallow. The food then is transported toward the back of your mouth where the swallow reflex is triggered. This initiates the pharyngeal phase of the swallow, which closes your vocal cords and moves your larynx to protect your airway from the food or liquid. The food bolus then passes through the pharynx (throat) and moves into your esophagus, which is the food tube located immediately behind your airway. A peristaltic wave then helps move the apple down through your esophagus where it is eventually emptied into your stomach.
Complications of Dysphagia: Aspiration
Aspiration occurs when there are problems with the coordination of your swallowing system. It occurs when food or liquid enters the airway rather than your esophagus and ultimately your stomach.
When a person aspirates, coughing typically follows to clear food or fluid out of the airway. If the aspirated food or liquid is not able to be cleared from the airway with a strong cough, it may infect the lungs and has the potential to become aspiration pneumonia.
“If there are neurological or physiological issues which affect the coordination of the muscles involved in any stage of the swallow or the ability of the airway to protect itself, there may be a disruption to a safe and efficient swallow. This increases the potential risk for aspiration. However, coughing is an important protective mechanism that can protect a person from complications related to aspiration,” stated Dr. Galgano.
Aspiration pneumonia is a potentially life-threatening infection which can arise when bacteria enters the lungs. What’s more, if you experience pain, discomfort, or any kind of unease when eating or drinking, it can be difficult to feel motivated or confident enough to eat and drink enough every day. This can lead to dehydration and malnutrition, which can exacerbate other medical conditions.
What Causes Dysphagia?
There are four stages of swallowing: the oral preparatory stage, oral transit stage, pharyngeal, and esophageal stage. Any disruption to the neurological control and coordination of the muscles involved in one or more stages of the swallow may result in dysphagia. Some of the causes of dysphagia are listed below.
Neurogenic disorders are some of the more common causes of dysphagia. These include acute onset injuries, such as stroke or brain injury, or gradual and progressive diseases, such as Parkinson’s disease, Alzheimer’s disease, dementia, Amyotrophic Lateral Sclerosis (ALS), or multiple sclerosis. These conditions affect the nerves responsible for the act of swallowing.
Congenital Structural Differences
These types of difficulties refer to anatomical differences in the facial, oral, or pharyngoesophageal structures of the body and can occur before birth and cause swallowing difficulties. Examples include an opening at the lip (cleft lip) or the roof of the mouth (cleft palate). These structural differences can cause difficulties forming an adequate suck pattern and can affect nursing and feeding in children.
Trauma and Other Conditions
Other conditions may cause swallowing difficulties due to damage to or dysmotility of the larynx or the esophagus. Trauma secondary to intubation from surgical intervention may cause temporary or long-term dysphagia, as can structural or physiological changes arising from changes due to head and neck cancer. Some medications may also cause difficulties that affect swallowing, such as delayed neuromuscular responses, mental cloudiness, fatigue, or xerostomia (excessive dry mouth) and may negatively impact swallowing function.
Autoimmune and inflammatory disorders, such as Myasthenia Gravis and muscular dystrophy can cause muscular weakness or reduced coordination, which can affect the body’s ability to perform one or more of the swallowing stages.
The natural progression of aging causes system-wide structural and physiological changes that may affect the strength and coordination of muscles involved in swallowing. Age-related changes may affect a person’s ability to adequately chew particular types of food textures, efficiently transfer food from the mouth to the stomach, and protect the airway in a timely manner.
Older adults are also more likely to be on medications which may create or exacerbate symptoms of dysphagia, putting individuals at risk for dehydration, nutritional deficits, and aspiration pneumonia.
Dysphagia Speech Therapy
Avoiding foods that cause you difficulty or preparing meals a particular way may ease symptoms or risks associated with dysphagia. However, it is still beneficial to see a licensed speech language pathologist (SLP) to help effectively diagnose and treat your condition, resolve issues, and support long-term health and quality of life.
A speech-language pathologist will conduct a series of tests that thoroughly examine the structural and physiological aspects of your oral motor mechanism and swallowing. These tests allow the SLP to determine which phase of swallowing is impacted, as well as the root-cause of your troubles.
“Results of these tests will help an SLP better understand your unique swallowing challenges to customize a plan of action with tailored exercises and strategies that will include a combination of strengthening exercises and compensatory techniques to improve the coordination, efficiency, and safety of your swallow,” Dr. Galgano said. “Your individualized plan of care may also include postural maneuvers and diet and environmental modifications to increase the overall ease and safety when eating and drinking.”
Some people may experience lip, tongue, and/or jaw muscle weakness affecting adequate chewing and bolus formation and may benefit from targeted exercises to improve the strength and range of motion of specific muscles. These types of difficulties may or may not co-occur with sensory changes and may benefit from strategies, such as modifying bite size, texture, and temperature. Some patients may also respond well to the use of specific maneuvers to support safe and efficient swallowing. An example of this could be performing an effortful swallow or tucking your chin when swallowing so food and liquids do not enter the trachea when swallowing.
Dysphagia Treatment at Open Lines
Following a consistent treatment plan and adhering to home exercise plan recommendations will help you meet your goals for easy, safe swallowing, helping you to enjoy eating and drinking again! Modifications to your treatment plan will be made along the way if they are needed to ensure you meet your established goals. Regular check-ups with your SLP are important to ensure gains you make in therapy will be maintained.
Contact Open Lines today by phone at (212) 430-6800, by email at info@OpenLinesNY.com, or through our contact form. If you or a loved one are ready to take the next steps in managing your dysphagia, request an appointment to discuss your goals and review our service options.