Eating and drinking is something we often take for granted and is the link to many social events, holidays, and celebrations. If swallowing is impaired, it can change quality of life.
Swallowing difficulty is called dysphagia. In the United States, 1 in 25 adults experience dysphagia annually. Dysphagia is often associated with specific conditions (i.e. stroke, head and neck cancer, neurological disease, trauma to the head and neck, respiratory disease, and advanced age), but can also occur during hospitalizations as a consequence of prolonged intubation and/or becoming deconditioned/weak. Severe cases of dysphagia can lead to dehydration, malnutrition, and aspiration pneumonia (an infection caused by food or liquid entering into the lungs), which may be life threatening.
Symptoms of Dysphagia
The most common symptom of dysphagia is coughing when eating or drinking. This is a sign that food and/or liquid is going into the airway, often referred to as the “wrong pipe”. If the material falls below the true vocal folds, this is known as aspiration. If a cough is not elicited when material enters the airway and falls below the true vocal folds, “silent aspiration” has occurred. This is most dangerous because a patient is completely unaware when this is happening. Other symptoms of dysphagia include throat clearing when eating/drinking, sensation of food sticking, weight loss, increased effort when swallowing, aspiration pneumonia, and food and/or liquid coming back up after it has been swallowed.
Evaluation and Treatment
Speech-Language Pathologists (SLPs) in the Department of Otolaryngology work closely with the otolaryngology team to evaluate and treat swallowing disorders in the UPMC Swallowing Disorders Center, the Head & Neck Cancer Survivorship Clinic, and in the hospital setting. “Our goal is to identify the cause of the swallowing problem by using instrumental swallow tests (fiberoptic endoscopic evaluation of swallowing (FEES) and/or videofluoroscopy, aka modified barium swallow (MBS)” says Tami Wasserman-Wincko, MS, CCC-SLP. “Once the problem is identified, a treatment plan is put into action.”
During the swallowing evaluation the SLP will implement postural changes (head turns, chin down, head tilt) , swallowing strategies (supraglottic swallow, bolus placement, liquid wash, effortful swallow, double swallow, cough- swallow), or diet modifications based on the physiology of the swallow. “These interventions can sometimes improve swallowing function immediately by preventing food/liquid from entering the airway or by reducing food sticking in the throat,” explains Wasserman-Wincko, Director of the Speech-Language Pathology Division in the Department of Otolaryngology. “Using an intervention that can result in a positive change can help a patient maintain an oral diet without the need of a feeding tube.”
A swallowing rehabilitation program consists of swallowing exercises to increase strength and to improve swallow efficiency. Exercise programs are tailored to meet the individual needs of each patient and the frequency of treatment is based on the symptoms and diagnosis. If the swallowing condition is caused by criopharyngeal dysfunction, Zenker’s diverticulum, and glotitic insufficiency, surgical intervention may be required by the ENT team.
Improving Treatment Strategies
For some, dysphagia is temporary and can be corrected with therapy. Others may experience a progressive decline due to the nature of their disease or condition. In severe cases of dysphagia, new rehabilitative methods for managing dysphagia need to be explored. Wasserman-Wincko adds that “Thanks to generous donations to the UPMC Swallowing Disorder Center and the Head & Neck Survivorship Clinic through the Eye & Ear Foundation researchers are able to identify best techniques to help patients reach their most functional swallowing outcomes.”
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