About dysphagia

Speech and language therapists play an important role in supporting adults who have eating, drinking and swallowing difficulties (dysphagia) to eat and drink safely. They do this by working directly with individuals or indirectly by training others, including families and the wide health and care workforce, to identify and manage problems.

Eating, drinking and swallowing difficulties have potentially life-threatening consequences. They can result in choking, pneumonia, chest infections, dehydration, malnutrition and weight loss. They can also make taking medication more difficult. Dysphagia symptoms include:

  • Taking a long time to chew
  • Food gets stuck in your throat
  • Changes in voice, including nasal or 'wet' speech
  • Difficulty chewing or controlling food in the mouth
  • Coughing or choking when swallowing
  • Changes in eating habits - e.g. eating slowly, or avoiding meals altogether
  • Significant, unintended weight loss
  • Recurrent chest infections or pneumonia
  • Food in the nose
  • General weakness, a noticeable change in mental status, and the overall effects of losing strength

How we can help

Dysphagia in adults is associated with a number of different conditions, including:

  • Stroke
  • Progressive neurological disorders, including dementia, Parkinson's disease, motor neurone disease, multiple sclerosis, and muscular dystrophy.
  • Cancer, including head and neck, lung, and oesophageal
  • Respiratory conditions, including chronic obstructive pulmonary disease, emphysema, and asthma
  • Learning disability, developmental and acquired disorders
  • Disorders of the immune system
  • Traumatic brain injury

Acutely ill patients in critical care beds, including those with cervical spinal injuries and those with community-acquired pneumonia, Guillain-Barre and influenza can also have dysphagia.  Acid reflux can also result in swallowing difficulties.

Assessment, diagnosis and management of swallowing difficulties

Speech and language therapists have a unique role in the assessment, diagnosis and management of swallowing difficulties. They:

  • Play a key role in the diagnosis of dysphagia
  • Help people regain their swallowing through exercises, techniques and positioning
  • Promote patient safety through modifying the texture of food and fluids, reducing the risk of malnutrition, dehydration and choking
  • Promote quality of life, taking into account an individual's and their families' preferences and beliefs, and helping them adjust to living with swallowing difficulties
  • Work with other healthcare staff, particularly dieticians, to optimise nutrition and hydration
  • Educate and train others in identifying, assessing and managing dysphagia, including families and the wider health and care workforce

  • Exercises can sometimes help to improve the muscles we use to swallow.
  • Strategies / postures can sometimes be used to improve the safety of the swallow.
  • Thickening fluids can sometimes make drinking safer.
  • Altering the texture of the diet can sometimes make eating safer.

  • Detailed and accurate assessment.
  • Accurate diagnosis of dysphagia which may assist with the differential medical thoughts.
  • Ensuring safety (reducing or preventing aspiration) with regards to swallowing function.
  • Balancing risk factors with quality of life, taking into account the individual's preferences and beliefs.
  • Working with other members of the team, particularly dieticians, to optimise nutrition and hydration.
  • Stimulating improved swallowing with oral motor/sensory exercises, swallow techniques and positioning.

The impact of speech and language therapy

Early identification and management of dysphagia by speech and language therapists improves quality of life, and reduces the possibility of further medical complications and death.  Improved nutrition and hydration have an impact on physical and mental wellbeing.

How swallowing difficulties are assessed

  • Clinical examination - look, feel, listen for signs of dysphagia using a stethoscope at times.

  • Videofluoroscopy - an x-ray where food and drink is mixed with barium so we can see exactly what happens when we swallow.

  • Fibreoptic Endoscopic Evaluation of Swallowing (FEES) - a small endoscope is passed through the nose to visualise the larynx (voice box) and airway during the swallow.