Dysphagia: Individualized treatment for people with swallowing disorders
The term “dysphagia” may be unfamiliar to most of us, but its symptoms are all too real if you experience it. The word simply means “difficulty swallowing.” During June—Dysphagia Awareness Month—we have an opportunity to learn about a process we all take for granted, and what can go wrong with this most seemingly natural of functions.
A complex process
First, let’s take a look at what happens when you swallow food. “Swallowing is a complex process involving multiple phases, muscles and nerves,” says Valentina Mocchetti, a speech and language pathologist specializing in swallowing disorders at the Sean Parker Institute for the Voice at Weill Cornell Medicine.
Swallowing takes place in three distinct phases:
- the oral phase, during which food is pushed from the mouth down into the throat;
- the pharyngeal phase, when it’s pushed from the back of the tongue to the top of the esophagus; and
- the esophageal phase, when food travels from the esophagus to the stomach.
“The entire process takes about 50 muscles to coordinate,” she says.
Problems can arise during one, two or all three phases of the swallowing function. Harder to explain are the causes of swallowing dysfunction, which are as numerous as they are diverse.
Causes and symptoms
Dysphagia can occur in patients across the lifespan, from infancy to old age, says Dr. Anaïs Rameau, an attending laryngologist at the Sean Parker Institute and an Assistant Professor of Otolaryngology at Weill Cornell Medicine. Its causes can be neurodegenerative—as in Parkinson’s or Alzheimer’s disease—anatomical, medication-related or resulting from an injury or infection, among other etiologies.
Swallowing dysfunction may also be caused by cancer or its treatments. It can be particularly severe in the aftermath of radiation therapy for cancers of the head and neck. It may also be produced by gastroesophageal reflux disease (GERD). It may even be a consequence of an eating disorder.
The list of common symptoms of swallowing dysfunction is almost as long and various as the list of its causes. These include but are not limited to:
- difficulty controlling liquid or food in the mouth
- pain when swallowing
- coughing or throat clearing before, during or after swallowing
- a sensation of food sticking in the throat or chest
- an inability to eat specific types of food
- extra effort needed to chew and swallow
- losing weight due to fear of swallowing
- repeated pneumonias or respiratory infections of unknown cause
The art and science of diagnosis and treatment
Swallowing specialists use a wide range of methods and technologies to evaluate patients with dysphagia. From specialized X-rays to endoscopy and tests that visualize swallowing in real time, diagnosing the problem and its source has become far easier and more targeted in recent years.
And based on the results, your specialist will individualize your treatment plan to match. More often than not, you may undergo swallow therapy with a speech pathologist like Ms. Mocchetti. Which food textures are problematic for you? Do you feel as if food is stuck in your throat? Does food or liquid go down the wrong way when you swallow? Your therapist will help you identify swallowing-friendly strategies to avoid such sensations and make life, and eating, much easier.
While there is no “one size fits all” treatment for dysphagia, many patients respond favorably to swallow therapy. A therapy plan may include targeted swallowing exercises that also need to be completed daily at home, like physical therapy exercises. “Swallow therapy takes commitment,” says Ms. Mocchetti, “but most people find it well worth the effort.
“Avoiding certain foods and even finding a different way to position the head can make a big difference,” she continues. “We may also work with patients to strengthen their tongue and their breath support.”
Sometimes, surgery is warranted, but the good news is that many procedures can be performed in the doctor’s office without general anesthesia. For example, some patients may require a procedure that stretches the upper end of the esophagus, using an endoscopic balloon. Patients suffering from dysphagia after radiation treatment may need surgical intervention to open a narrowed esophagus.
Older patients in particular may do well with vocal fold medialization—a procedure that pushes the folds towards each other, allowing them to close during voicing and swallowing. Medialization, says Dr. Rameau, alleviates problems with water and also helps to create a more efficient cough, leading to significant improvement in the swallowing function, as cough is an important rescue mechanism for clearing the airway when swallowing is dysfunctional.
Is dysphagia a disorder or a symptom?
As Dr. Rameau explains, dysphagia is not a true disorder, nor is it a syndrome unto itself. Mostly, it is a symptom—one that ranges from mild to quite severe and can be traced to a variety of causes.
Much depends on patients’ experiences, gathered in an initial questionnaire. “The patient may not actually be in any danger,” Dr. Rameau says. “Dysphagia isn’t always indicative of something terrible. That is why we conduct so many tests before arriving at a definitive diagnosis and course of treatment.”
It is also why there are many reasons to be hopeful. If you experience difficulty swallowing, there are many ways to improve or even restore that most natural of functions, and your quality of life.
To receive more information about dysphagia or to make an appointment with a clinician, visit the Sean Parker Institute for the Voice.
You are also invited to attend a virtual seminar on Wednesday, June 15 at 5:00pm titled, Swallowing Disorders in Adults: From Diagnosis to Innovative Solutions, featuring Dr. Rameau and Ms. Mocchetti. Please register here.