What is Dysphagia?

Dysphagia is the medical term for difficulty or discomfort with swallowing.

Dysphagia symptoms: Each person is different, but some of the common symptoms of this disorder are as follows:

  • coughing during, or right after, eating and/or drinking

  • wet or gurgly sounding voice during or after eating and/or drinking

  • extra effort or time needed to chew or swallow

  • food or liquid leaking from the mouth or getting stuck in the mouth and/or throat

  • recurring pneumonia or chest congestion after eating

  • weight loss or dehydration

Dysphagia causes include (but not limited to):

  • Progressive Neurological Disease – Parkinson’s Disease, Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s), Multiple Sclerosis, Myasthenia Gravis, Muscular Dystrophy, Alzheimer’s Disease, etc.

  • Traumatic Brain Injury (TBI) – Motor Vehicle Accident (MVA), fall, blunt trauma, etc.

  • Head, Neck, and/or Esophageal Cancer – Rad/Chemo, Reconstructive Surgery, etc.

  • Nervous System Infections – Meningitis, Tuberculosis, Encephalitis, etc.

  • Cerebral Vascular Accident (CVA) – Stroke

  • Spinal Cord Injury (SCI)

  • Gastroesophageal Reflux Disease (GERD)

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Respiratory Failure – Tracheostomy & Ventilator

  • Deconditioning/Weakness from Lengthy Hospitalization

  • Status Post Intubation from a Surgery

  • Encephalopathy

  • Aging Process

  • Bell’s Palsy

  • Guillian Barre Syndrome

  • Cleft Lip and/or Palate

Because its causes are so vast, it is usually poorly understood and, unfortunately, is often under diagnosed.

Why it matters…

Most of our entertainment and important occasions here in the US revolve around food.

For those who struggle with dysphagia, everyday life is significantly affected and can feel as if it ceases to exist altogether.

Dysphagia can cause depression, weight loss/malnourishment, decreased social interaction or isolation, and increases serious health risks such as aspiration pneumonia and even death.

How is dysphagia diagnosed?

Speech Language Pathologists complete clinical bedside swallow exams (CSE) in hospitals, skilled nursing facilities and rehabilitative facilities in order to formulate an educated hypothesis regarding the possible nature of a patient’s swallowing deficits utilizing trial interventions and strategies across various consistencies, when instrumental testing is not warranted or available.

Although quick and informative, the CSE cannot properly diagnose swallowing pathophysiology because although highly educated and trained, we SLPs DO NOT have x-ray vision. Without VFSS and/or FEES, SLPs cannot make physiology-based treatment decisions. We end up treating the symptom—and not the cause—of the disease.

Residents in healthcare facilities wait an average 2-6 weeks to complete costly imaging studies at local hospitals. Leading to longer hospital stays, higher inpatient costs, higher likelihood of discharge to post-acute care facilities, and increased mortality rates.

Diagnostic Imaging: VFSS and FEES

Instrumental swallow assessments are conducted by SLPs using either videofluoroscopic swallowing study (VFSS) or flexible endoscopic evaluation of swallow (FEES)

Image: Endoscopic evaluation of oral and pharyngeal phases of swallowing Susan E. Langmore. GI Motility online (2006)

VFSS

Advantages

  • Assess oral, pharyngeal phases of swallow

  • Can screen the esophagus

  • Can visualize the airway before, during and after the swallow

Disadvantages

  • Report

  • Radiation exposure

  • Limited duration of exam

  • Limited availability

  • Positioning limitations (kyphosis, contractures)

  • Limited foods that are barium-coated

  • Transportation

  • Expensive resources: room, personnel (MD, SLP, tech)

  • Weight limit (fluoro chair)

  • Less sensitive for microaspiration

  • Need for contrast

FEES

Advantages

  • Direct visual of mucosa, structures, vocal folds

  • No time limit

  • Real food (no barium)

  • No radiation exposure

  • No transportation/ mobile

  • No weight limit

  • Less expensive than VFSS

  • Often more accessible /availability

  • Visualization of secretion management

  • Full report obtained same day

Disadvantages

  • White out period during the swallow

  • Does not assess oral phase of swallow

  • Cannot screen the esophagus, only backflow

  • Nasoendoscopy discomfort (reduced with small diameter)

  • Time consuming disinfection process (eliminated with disposable scope)

Increase safety

Reduce costs

Improve quality of life

Prevent these dysphagia-related consequences, minimize costs and significantly improve quality of life using FEES.

Making meals FEESable