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About Dysphagia

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Dysphagia is a complex disorder of the swallowing mechanism. This page does not attempt to be an in-depth basis of dysphagia but an overview.

Dysphagia Statistics

 

An estimated 15 million people in the United States have the current diagnosis of dysphagia.

Approximately one million people annually receive a new diagnosis of dysphagia.

Nearly 60,000 people die each year from complications associated with swallowing disorders.

 

According to the National Institute of Deafness and Other Communication Disorders, people with dysphagia have difficulty swallowing and may also experience pain while swallowing. Some people may be completely unable to swallow or may have trouble swallowing liquids, foods, or saliva. Eating then becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body.

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Swallowing is a complex process. In a normal swallow, approximately 50 pairs of muscles and many nerves work to move food from the mouth to the stomach. The swallowing process occurs in three different stages.

First, the tongue moves the food) around in the mouth for chewing. Chewing makes the food the right size to swallow and helps mix the food with saliva making it a bolus. Saliva softens and moistens the food to make swallowing easier. During this first stage, the tongue collects the prepared food or liquid, making it ready for swallowing.

The second stage begins when the tongue pushes the food or liquid to the back of the mouth, which triggers a swallowing reflex that passes the food through the pharynx. During this stage, the larynx closes tightly and breathing stops to prevent food or liquid from entering the lungs.

The third stage begins when food or liquid enters the esophagus. This passage through the esophagus usually occurs in about 3 seconds, depending on the texture or consistency of the food.

Dysphagia occurs when there is a problem with any part of the swallowing process. Weak lingual or masseter or buccal muscles may make it hard to move food around in the mouth for chewing.

Other problems include not being able to activate the swallowing reflex because of a stroke or other nervous system disorder. People with these kinds of problems are unable to begin the muscle movements that allow food to move from the mouth to the stomach. This happens because of delayed sensation at the faucial pillars. Another difficulty can occur when weak pharyngeal and esophageal muscles cannot move all of the food toward the stomach. Bits of food can fall or be pulled into the (trachea), which may result in aspiratoin pneumonia.

Dysphagia has a variety of etiologies. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson's disease, will develop problems with swallowing. Additionally, stroke or head injury may affect the coordination of the swallowing muscles or limit sensation in the mouth and pharynx. An infection or irritation can cause narrowing of the esophagus. People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with cleft palate are unable to suck properly, which complicates nursing and drinking from a regular baby bottle.

In addition, cancer of the head, neck, or esophagus may cause swallowing problems. Sometimes the treatment for these types of cancers can cause dysphagia. Injuries of the head, neck, and chest may also create swallowing problems. Other etiologies include tracheostomy, pneumonia, medications, surgery, pulmonary diseases, metabolic problems, autoimmune disease, severe dementia, gastroenterological problems, and psychiatric problems.

There are several signs and symptoms of aspiration that a speech-language pathologist (SLP) looks for when completing a swallowing assessment. One of the main symptoms would be whether or not the person is coughing. The coughing means that there is part of the bolus resting on the vocal folds and it is the body's natural reaction to try to expel it and protect the airway. The person might also have gurgly breathing, whispery or no voice, attempt to clear his or her throat, or a change in respiration. He or she might complain of a feeling like something is "stuck in the throat". The person could also shows signs of reddening in the face, watering of the eyes, facial grimacing, and chest pain.

Tiffany Ayers, Lauren Keller, Tyler Lee, Megan Michie, Ashley Rager

Western Kentucky University
Department of Communication Disorders
Graduate Studies