What is Dysphagia?

Dysphagia is the medical term term used for difficulty swallowing. 

Pronunciation - dis-fay-juh

People with dysphagia have difficulty swallowing and may even experience pain while swallowing (odynophagia). Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body and can lead to additional serious medical problems. 

Like breathing, swallowing is a reflex and essential to everyday life. Humans swallow at least 900 times a day: around three times an hour during sleep, once per minute while awake and even more often during meals. We swallow food, liquids, medicine and saliva. People who have trouble swallowing are at risk of poor nutrition and dehydration, while babies and children may not take in enough nutrients to support growth and brain development. 

The swallowing system is a tube in which a series of pumps and valves move food and drink from the mouth to the stomach. In the throat, the tube branches in two directions; down one, the food and drinks pass into the oesophagus on their way to the stomach, while the other branches off to the voice box and lungs and is used for breathing.

With each swallow we hold our breath for around one second to make sure the food or drink travels down the correct tube to the stomach rather than the lungs. Swallowing uses 26 muscles and many nerves to coordinate the split-second timing needed to safely swallow and mistimed movements can lead to food or drink ‘going down the wrong way’. 

Swallowing skills develop from infancy. Babies drink milk, from their mother’s breast or a bottle, using muscles in their lips, tongue, jaw and cheeks. The infant holds the nipple at the back of their mouth and the milk triggers the swallow reflex. When children start to eat solid food, they learn to move the food from the front of the mouth to the back to trigger the same swallowing reflex. Chewing is also important – food mixes with saliva and is broken into tiny pieces so that it forms a soft slippery ball that is easy to safely swallow.

How Does a Swallowing Problem Occur?

A swallowing difficulty (dysphagia) is any problem with: sucking, swallowing, drinking, chewing, eating, controlling saliva, taking medication, or protecting the lungs from food and drink ‘going the wrong way’. It can be a problem with keeping the lips closed so that food, liquid or saliva doesn’t dribble out. Sometimes, the first sign of a swallowing problem is coughing, gagging or choking when eating and drinking. Swallowing problems can mean food, drinks or saliva get into the lungs and this can cause lung infections (pneumonia). 
Reflux is a problem where the valves in the oesophagus cause the contents of the stomach (like food, drink or stomach acid) to come back up, sometimes reaching as far up as the throat and mouth. Who can have a swallowing problem? A swallowing problem can occur at any stage in life. Babies born prematurely, those with heart defects or damage to the brain (e.g. cerebral palsy) often have swallowing problems. Children with abnormalities in the structures of the head, neck and face such as cleft lip or palate may also have difficulty feeding.

Causes of Dysphagia

Adults may also develop swallowing problems as a result of damage to the brain or structures of the head and neck. Almost half of everyone who has had a stroke will have a swallowing problem. People who have had a head injury, those with Parkinson’s disease, motor neuron disease, dementia, cancer of the head and neck may also have swallowing problems.
The impact of swallowing problems may be short or long term and can have a big impact on a person’s life. If you think you or a loved one might have a swallowing problem, make sure you get help. Eating and drinking is an important part of everyday life. Not only do we need to eat and drink to live but eating and drinking should be an enjoyable pastime and many social activities happen around eating and drinking. 
Swallowing problems can result in life threatening medical problems such as pneumonia, choking, poor nutrition and dehydration, if not managed properly. In babies and children, poor nutrition may impact on growth and brain development. Eating and drinking can be uncomfortable, stressful and frustrating for a person with swallowing problems. They can’t have some types of food and drink and symptoms of swallowing problems can make eating and drinking in front of friends and family difficult and embarrassing. These problems can lead to anxiety, depression and social isolation. 

How is Dysphagia Diagnosed?

The good news is that people who seek professional help can work on ways of eating and drinking that can reduce or remove these problems. What can be done about swallowing difficulties? Early identification is very important. If you notice any of the signs or symptoms below see your doctor and/or refer yourself directly to a speech pathologist. 

  • Your baby has difficulty sucking during breast or bottle feeding
  • A feeling that food or drink gets stuck in the throat
  • A feeling that food or drink is going the wrong way
  • Long meal times or eating slowly (it takes more than 30 minutes to finish a meal)
  • Coughing, choking or frequent throat clearing during or after eating and drinking
  • Becoming short of breath or your breathing changes when eating and drinking
  • Avoiding certain foods because they are difficult to swallow
  • Unplanned weight loss for adults or for children, or failing to put on weight because of avoiding foods or finding it hard to eat
  • Frequent chest infections with no known cause 
Speech Pathologists may recommend changes to the textures of foods or drinks and provide rehabilitation techniques and exercises to help people swallow safely. If the swallowing problem is very severe, a speech pathologist may recommend the person take food and drink via a tube that goes directly to the stomach. Speech pathologists work with other health professionals such as doctors, nurses, dieticians, occupational therapists, physiotherapists and others to help people with swallowing problems.

Who Do Swallowing Disorders Affect?

More than 1 Million Australians have difficulty swallowing, including:

  • 33% of people with Multiple Sclerosis
  • 50% of people with Parkinson's Disease
  • 95% of people with Motor Neurone Disease
  • 15% of people with learning difficulties
  • 68% of people with dementia in care homes
  • 65% of people who have had a stroke

A Swallowing Disorder May Also Affect: 

  • 15-30% of people aged 65% living in the community
  • 50% of older adults in nursing homes
  • 84% of people with Parkinson's disease
  • 100% of people with Alzheimer's at some point in their disease progression
  • 20% adults with mental health disorders
  • 45% of patients with head and neck cancer, post chemoradiotherapy
  • 40% of stroke survivors have an ongoing need for support for swallowing

Interesting Swallowing Facts

  • People swallow 700+ times per day (on average)
  • Swallowing uses 26 muscles
  • Humans Swallow once per minute while awake, around 3 times an hour during sleep and even more during meals!

Acknowledgement - Speech Pathology Australia
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