Adult Swallowing Difficulties

Dysphagia can occur at any age, but it’s more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause. There are many conditions that can cause swallowing problems. Some medications can cause a dry mouth, which makes it hard to chew and swallow. Other causes include the following:

1. Damage to your part of your brain or nerves from:

• Stroke
• Brain Injury
• Parkinsons Disease
• Motor neurone disease (MND)/ Amyotrophic lateral sclerosis (ALS)/ Lou Gehrig’s disease
• Multiple sclerosis (MS)
• Friedreich ataxia
• Huntington’s disease
• Muscular dystrophy
• Cerebral palsy
• Alzheimer’s disease

2. Problems with your head or neck, such as:

• Cancer in your mouth, throat, or esophagus^[4]
• Mouth or neck surgery^[5]
• Poor dentition; decaying teeth, missing teeth, or dentures that do not fit well^[6]

Problems affecting the control of the swallowing process can cause food or drink to drip into the lungs or become lodged in the airway.

For most of us, a small amount of saliva falling into an open airway or into the lungs will trigger a reflexive cough to cough it up. In reality, it doesn’t do much harm. However, for someone who has had a stroke or some other neurological disease, the body’s reflexes to protect the airways may not operate effectively at all, and the sensations that trigger the reflex coughing may also not work. This means that the food and drink may be at risk of falling into an open airway.

The lungs are warm and moist, a perfect breeding ground for bacteria. This means food and drinks falling into the lungs are at risk of starting a chest infection. For a healthy person who is mobile, walking around or exercising can help the fallen food/ mucous move upwards to be coughed out.

For someone who is already weakened or not actively mobile, this can develop into a serious chest infection, also known as an aspiration pneumonia. When undetected or unmanaged, this can be fatal. This is why when there are swallowing concerns in hospital, patients are placed ‘nil by mouth’  meaning they are not able to eat or drink until their swallow safety has been assessed by a speech pathologist, who must see them within 24 hours of the referral.

When someone is discharged home, they may have some speech pathology recommendations to manage an ongoing swallowing problem.

This may include:

• Modified food textures or thickness of drink.
• Recommendations to sitting position at mealtimes
• Techniques to use when swallowing
• Therapy exercises to increase muscle tone/strength for swallowing

These will need to be reviewed by a speech pathologist either through hospital outpatient services or by private speech pathology.

After an acquired brain injury, a speech pathologist is able to provide a ‘swallowing therapy program’ specifically to strengthen the muscles for coordinating swallowing.

In the case of progressive or deteriorating conditions, a speech pathologist can provide strategies to compensate, or potentially slow the rate at which changes to textures to food and drink need to be made. Our mission is always to help you maintain the quality of your life through the enjoyment of food and drink, but also make sure you can do this safely.

General signs of a swallowing difficulty include:^[7][8]

• Coughing during or right after eating and/or drinking
• A wet or gurgly sounding voice during and/or after eating or drinking
• Extra effort or time needed to chew or swallow
• Food or liquid leaking from your mouth onto your clothes
• Food getting stuck in areas of your mouth
• Having a hard time breathing during and/or after meals
• Rapid weight loss
• Excess saliva

As a result, you may have experienced:

• Dehydration or poor nutrition
• Food or liquid going into the airway, called aspiration
• Pneumonia or other lung infections

You may feel embarrassed when eating. You may feel bad about your swallowing problems and want to eat alone.

At Talkshop Speech Pathology, our speech pathologists will assess you to see how you are eating and drinking. Our clinicians are experienced in working with adults and children with swallowing disorders. Swallowing assessments are usually done in the comfort of your own home.

The Speech Pathologist will:^[9]

• Ask you about your health, past illnesses, surgeries, and your swallowing problems
• Do an oro-motor assessment. This is an assessment of your cranial nerves and the anatomy and physiology of the muscles supporting the swallowing process.
• We will assess how your well your swallowing is able to cope with different food and drink textures
• Assess how swallowing ability can also change with fatigue. One of the things we observe is whether you are safe to eat and drink throughout a mealtime without becoming too tired and being at risk of choking or aspirating.
• Review how well you are able to independently follow swallowing strategies during mealtimes
• Review level of support needed to prepare food and drinks.
• Refer you to do further testing if needed.

The focus of the treatment you need will depend on the problems you have. At Talkshop our speech pathologists can work with you to improve how you swallow. We might suggest:^[10]

• Treatment to help you use your muscles to chew and swallow
• Ways you should sit or hold your head when you eat
• Strategies to make your swallow better and safer
• Trialling differently textured food or drinks which are an easier texture to swallow safely.

Typically we will book in a block of sessions. Sessions are usually 45 mins in length. Swallow therapy sessions are usually done in your home.

We may refer you to other health professionals to further assist or monitor issues associated with swallow issues:

• GP – e.g management of underlying condition
• ENT – e.g  to review possible reflux
• Dietitian – e.g to ensure adequate nutrition and hydration
• Pharmacist – e.g to manage swallowing tablet medications

If you have concerns about someone’s swallowing safety please contact us immediately or contact your GP.

If you have questions about your child’s swallowing/feeding/eating difficulties please call us or and read here for more information