Trouble Swallowing? A Speech-Language Pathologist Can Help

There are several reasons why you might be feeling pain or discomfort when swallowing, called dysphagia. It could be something physiological such as acid reflux, it could be a neurological issue related to a diagnosis, such as a stroke, Parkinson’s disease, or other progressive diseases, like Alzheimer’s, Amyotrophic Lateral Sclerosis (ALS), or Multiple Sclerosis (MS). 

If you often cough during or after meals, feel short of breath while eating, or notice changes in your voice after eating or drinking, it may be time to schedule a swallowing evaluation with a speech-language pathologist (SLP) at the Speech-Language Institute (SLI). 

“At SLI, we also have an objective measurement where we can see inside the throat called a flexible endoscopic evaluation of swallow (FEES). We have the instrumentation available for our clients so we can see what happens to them when they are consuming different textures and how it affects their swallow safety and function,” said Erika Cardamone, MS, CCC-SLP, an SLP clinical educator who has a wide range of experience in treating children and adults with communication and swallowing disorders. “Based on what we find, we develop a treatment plan.” 

SLPs access a client’s ability to swallow different textures, starting with thin liquids like water and progressing to thicker liquids such as nectar or smoothie-like consistencies. They will also evaluate different types of solids, from purees and mashed solids to crunchy, chewable items. Throughout the evaluation, they’ll examine all stages of the swallowing process, which actually begins at the lips. 

“Diagnosis is the first step, and we can do that by gaining past medical information and assessing different textures during swallowing,” said Cardamone. 

The Swallowing Process 

Swallowing happens in four phases. You can have a problem in one or more of these phases, which include: 

• Oral prep phase – food is chewed and mixed with saliva to form a bolus, a small rounded mass of a substance, especially of chewed food, at the moment of swallowing.
• Oral phase – the bolus is sent to the base of the tongue and triggers the swallow reflex.
• Pharyngeal phase (throat) – The bolus travels past the base of the tongue, the larynx elevates, the epiglottis inverts, and the vocal folds close to protect the airway. Food or liquid going into the airway is called aspiration and can cause coughing and choking.
• Esophageal phase – The esophagus opens and peristalsis – the process of wave-like muscle contractions that move food through the digestive tract - squeezes food down to the stomach.

Signs of Swallowing Disorders 

• Pain while swallowing
• Unable to swallow
• Coughing or choking during or after meals
• A wet or gurgling-sounding voice during or after eating or drinking
• Feeling like something is stuck in your throat or chest after eating or drinking
• Drooling
• Bringing food back up
• Frequent heartburn
• Having food or stomach acid back up into your throat
• Weight loss

Causes of Swallowing Disorders 

• Stroke
• Traumatic brain injury
• Parkinson’s disease
• Multiple Sclerosis
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
• Muscular dystrophy
• Cerebral palsy
• Alzheimer’s disease
• GERD (gastroesophageal reflux disease)
• Cancer in your mouth, throat, or esophagus
• Head or neck injuries
• Mouth or neck surgery
• Bad teeth, missing teeth, or improperly fitting dentures

How is success with treating swallowing disorders measured at SLI? According to Cardamone, re-evaluation of the issue after a therapeutic course of exercises to measure the progress of the client’s improvement is one way. Client report and involving the client in every step of the evaluation and treatment is another.  

To schedule an appointment today, call SLI at 215.780.3150.