Dysphagia involves difficulty moving food, liquids, or saliva from the mouth to the stomach, affecting the oral, pharyngeal, or esophageal phase of swallowing. It is a symptom of various underlying conditions that impair the neuromuscular control or structures involved in swallowing. SLPs primarily address oropharyngeal dysphagia, which impacts the oral and pharyngeal phases, while esophageal dysphagia is often managed by gastroenterologists. The condition ranges in severity from mild difficulty with certain textures to complete inability to swallow, sometimes requiring tube feeding. Dysphagia can be acute (e.g., post-stroke) or progressive (e.g., in Parkinson’s disease or ALS), and it affects individuals across the lifespan.
Common signs include coughing or choking during meals, a sensation of food sticking in the throat or chest, pain with swallowing, or difficulty initiating a swallow. Silent aspiration—when food or liquid enters the airway without a cough—can lead to respiratory complications. In the oral phase, chewing difficulties or food pocketing may occur; in the pharyngeal phase, delayed swallow reflexes can leave residue in the throat. Esophageal issues may involve strictures or spasms causing regurgitation. Due to the complexity and health risks of dysphagia, SLPs often collaborate with other specialists and rely on clinical and instrumental assessments to guide treatment.
1. Oropharyngeal Dysphagia: Oropharyngeal Dysphagia involves impaired coordination of oral and pharyngeal muscles, making it difficult to safely transfer food or liquid from the mouth to the esophagus.
2. Esophageal Dysphagia: Esophageal Dysphagia is characterized by difficulty moving food through the esophagus due to structural abnormalities or motility disorders.
1. Neurological Disorders: Many neurological conditions can impair the complex coordination required for swallowing. Stroke—especially in the brainstem—is a leading cause of sudden-onset dysphagia, while progressive diseases like Parkinson’s, ALS, and advanced dementia commonly result in gradual decline in swallowing function. Disorders such as MS, myasthenia gravis, traumatic brain injury, and high spinal cord injuries may also disrupt neural control of swallowing through impaired motor pathways or cranial nerves.
2. Structural and Mechanical Causes: Changes to the anatomy of the head, neck, or esophagus can lead to dysphagia. Tumors, surgeries (e.g., laryngectomy), or radiation in head and neck cancer can alter swallowing mechanics. Other examples include esophageal strictures, Zenker’s diverticulum, or congenital anomalies like cleft palate. Even nonmalignant issues such as enlarged tonsils or cervical osteophytes can obstruct the swallow pathway.
3. Muscular Disorders: Muscle diseases like muscular dystrophies or polymyositis can weaken the muscles involved in swallowing. Myasthenia gravis causes fatigue-related swallowing difficulty, worsening with repeated attempts. Achalasia, an esophageal motility disorder, results in food remaining stuck in the esophagus due to sphincter dysfunction and also causes significant dysphagia.
4. Aging and General Medical Conditions: Aging leads to natural declines in swallowing efficiency (presbyphagia), which may worsen with illness or frailty. Intubation, sedative medications, or dry mouth can also impair swallowing. GERD contributes to dysphagia by causing strictures or reflexive laryngeal disruption. Cognitive or psychiatric conditions may further complicate swallowing due to poor alertness or cooperation during meals.
Management of dysphagia is a core responsibility of medical SLPs, as swallowing impairments directly affect health and safety. SLPs assess swallowing and recommend appropriate interventions, often as part of a hospital or rehabilitation team. Immediate strategies may include diet modifications (e.g., thickened liquids or pureed foods) and compensatory techniques like chin tucks or the supraglottic swallow to reduce aspiration risk. Rehabilitative exercises target specific deficits, such as tongue or laryngeal weakness, and may include maneuvers like the Mendelsohn or Shaker exercises, sometimes combined with neuromuscular electrical stimulation. SLPs also educate patients and caregivers on safe feeding practices to prevent choking.
In severe cases, they may help guide decisions about alternative nutrition, such as recommending temporary feeding tubes when oral intake isn’t safe. As conditions evolve—such as stroke recovery or progression of neurological disease—SLPs adjust care plans accordingly. They also support families in navigating the balance between safety and quality of life, including risk feeding choices in palliative care. Advocacy is another key role: SLPs train staff to follow swallowing guidelines and identify early signs of dysphagia. Through effective management, SLPs help reduce medical complications, support nutrition, and restore dignity to eating, highlighting the medical expertise at the heart of their profession.
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Chilukuri, Prianka, Florence-D. Odufalu, and Christine Hachem. “Dysphagia.” Missouri Medicine 115, no. 5 (2018).
Humbert, Ian A., and Georgia A. Malandraki. “Introduction to Adult Neurogenic Dysphagia.” Perspectives on Swallowing and Swallowing Disorders 23, no. 1 (2014).
