What is Dysphagia?

Dysphagia is defined as “difficulty swallowing” (Greek root dys meaning “difficulty” and phagia meaning “to eat”).   Swallowing problems are classified in three main phases: the oral phase (the mouth and area where chewing occurs), the pharyngeal phase (the throat at the back of the mouth behind the uvula and extending downward), and the esophageal phase (the tube that connects the throat to the stomach).  The swallow mechanism’s purpose is to close off the trachea (wind pipe) and direct food, liquid, pills, and saliva to the esophagus (swallowing pipe).   When a patient’s swallow muscles are not functioning properly, he/she can become at risk for other medical problems.  One common, high risk complication arising from dysphagia is aspiration pneumonia, a type of pneumonia caused when solids, liquids, and/or saliva enter the lungs (aspiration) and an infection forms.

If a patient appears to be at risk for this type of aspiration (solids, liquids, and/or saliva entering the lungs), his/her physician may refer the patient to a Speech Language Pathologist (SLP) for a swallow evaluation. This profession may also be known as a Speech Therapist (ST).  SLPs are only about 50-60% accurate in identifying aspiration at bedside or in the dining room, supporting the need for INSTRUMENTAL swallow evaluations to make accurate recommendations.  There are two main types of instrumental swallow evaluations:  (1) a modified barium swallow study (MBSS), also known as a video fluoroscopic swallow study OR a videoswallow and (2) a fiberoptic endoscopic evaluation of swallow (FEES).   These two instrumental assessments identify whether the patient is aspirating material (food, drink, saliva, pills) into the larynx/trachea/lungs.  These procedures also aim to trial various solid/liquid consistencies and strategies/techniques to see if swallowing can be made easier and safer for the patient.  A Speech Language Pathologist (SLP) is the healthcare professional specialized in treating dysphagia. Other pt care modalities of the SLP include voice, speech, language, and cognition.

birds eye view pic
Bird’s-eye view of larynx as viewed during FEES procedure
  1. Valleculae
  2. Epiglottis
  3. Aryepiglottic Folds
  4. False Vocal Folds
  5. Ventricular Space
  6. True Vocal Folds
  7. Airway/Trachea
  8. Arytenoids
  9. Lateral Channels
  10. Pyriform Sinuses
  11. Interarytenoid Space
  12. Anterior Commisure
  13. Posterior Commisure
  14. Esophageal Opening

Dysphagia can be a result of many medical diagnoses including, but not limited to:

  • Progressive Neurological Disease – Parkinson’s Disease, Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s), Multiple Sclerosis, Myasthenia Gravis, Muscular Dystrophy, Alzheimer’s Disease, etc.
  • Traumatic Brain Injury (TBI) – Motor Vehicle Collision (MVC), fall, assault, etc.
  • Head, Neck, and/or Esophageal Cancer – Rad/Chemo, Reconstructive Surgery, etc.
  • Nervous System Infections – Meningitis, Tuberculosis, Encephalitis, etc.
  • Cerebral Vascular Accident (CVA) – StrokeDiagram of dysphagia
  • Spinal Cord Injury (SCI)
  • Gastroesophageal Reflux Disease (GERD)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Respiratory Failure – Tracheostomy & Ventilator
  • Deconditioning/Weakness from Lengthy Hospitalization
  • Status Post Intubation from a Surgery
  • Encephalopathy
  • Aging Process
  • Bell’s Palsy
  • Guillian Barre Syndrome
  • Cleft Lip and/or Palate