Although an estimated 18 million people suffer from swallowing problems, eating and drinking is something that we take for granted. Difficulty swallowing, also known as dysphagia, is an interruption of the process of food and or liquid going from the mouth to the esophagus. Dysphagia can be caused by a stroke, trauma to the head or neck, a progressive neurological disease, amyotrophic lateral sclerosis (Lou Gehrig’s Disease), myasthenia gravis, multiple sclerosis, Parkinson’s disease) or a mechanical problem that prevents food from entering the esophagus, or accidentally diverts it into the airway. If food or liquid goes down the “wrong pipe” and into the lungs, it is known as aspiration. Aspiration can lead to a life threatening condition, known as aspiration pneumonia. Those with head and neck cancer may experience difficulty swallowing following surgery and/or during and after chemoradiation therapy. Dysphagia can affect people of all ages; however, those with advanced age may have more problems especially if they are suffering from an illness that makes them weak and deconditioned.
The UPMC Swallowing Disorders Center is dedicated to the treatment of patients with dysphagia. The team in the Swallowing Disorders Center consists of otolaryngologists and speech-language pathologists. Whether the swallowing problem is temporary or becomes progressively worse, a specialist can guide the patient through the process. The first step is an evaluation to properly diagnose the problem. During the evaluation process, the different phases of swallowing (oral, pharyngeal, esophageal) are carefully analyzed. If food and /or liquid enter the airway then different strategies are tried immediately to improve swallowing. Strategies may include: turning the head to the affected side, chin down posture, effortful swallow, and breath hold technique. Also, eating smaller bites of food, taking a drink to rinse, or changing the texture of the food/liquid will often make a difference.
A swallowing therapy program is the next step and is usually done over a course of 8 weeks. The therapy program is individually designed to treat specific problems. In the case of severe dysphagia, the therapy may concentrate on initiating a swallow or practicing techniques to protect the airway from aspiration. Often, the goal of therapy is to improve strength and endurance by exercising muscles of the tongue and throat. Sometimes, biofeedback is incorporated with EMG or pressure sensing devices to give objective measures of progress. Since therapy is usually offered weekly, the patient is expected to follow a home program to optimize results. In certain cases, a surgical procedure may be an adjunctive or even primary treatment for dysphagia.
A follow-up examination is usually conducted at the end of treatment to determine if progress has been made. If the goals have not been achieved, the patient may require further rehabilitation. Research in dysphagia is important to improve and identify new methods of treatment. The UPMC Swallowing Disorders Center is currently participating in a multi-center study involving a special device to activate the tongue. The device measures baseline tongue pressures so patients can improve strength with practice and aim to achieve specific target goals.