Oxford defines dysphagia as "difficulty or discomfort in swallowing.” More precisely, it is any disruption in a person’s ability to safely or efficiently move food/liquid/pills/saliva from the mouth to the stomach. This disruption can occur anywhere along that pathway — the mouth, the throat, or in the esophagus. The why and what to do about it gets more complicated and requires the guidance of a skilled team of experts that know you and your specific situation. For this reason, I will not try to explain every nuance of swallow function that may or may not apply to you here. If you really want to dive deep, there are some great websites and articles out there that delve into the nitty gritty of swallow function. If you or a loved one is experiencing dysphagia for the first time, I suggest the National Foundation for Swallowing Disorders as a great place to start. I’ve also included some answers to frequently asked questions about dysphagia below, written in plain English.

FAQs

Is dysphagia a disease?

No. It’s actually more of a symptom, or side effect, of another medical condition, a neurological event, trauma, a surgery, or medication.

Is it permanent?

It depends on what’s causing it. Dysphagia can be temporary, chronic, or progressive.

An example of a temporary or transient dysphagia would be when a person is so acutely ill or confused that they simply aren’t alert enough to eat and drink safely. This type of dysphagia tends to resolve as the person’s general status improves.

A chronic dysphagia is one that is longstanding. An example of a chronic dysphagia would be if someone has nerve damage effecting the mouth or throat muscles, or after a medical intervention that permanently alters the swallow physiology (for example, surgery or radiation for cancer of the head and neck).

Progressive dysphagia may be seen in conjunction with a progressive neurological condition, such as dementia, Parkinson’s Disease, ALS, or Multiple Sclerosis. In these cases, the severity of dysphagia may advance along with the course of the illness.

Dysphagia after a neurological event like a brain injury or stroke, or after a surgery, may be transient or chronic, depending on the severity and extent of damage to the areas controlling swallow function.

How do I know if I have dysphagia?

A speech-language pathologist is one of the primary medical professionals who can assess, diagnose, and treat dysphagia when it involves the mouth and/or throat. A speech-language pathologist may evaluate your swallowing in one or more of the following ways:

• Clinical Swallow Evaluation — They will talk to you about the history of your swallowing difficulties, assess the movement and sensation of your mouth muscles, and watch you eat and drink various items.

• Modified Barium Swallow Study (aka Videofluoroscopic Swallow Study) — This is basically an x-ray video of a person while they are swallowing different textures. It’s done in an x-ray suite with a speech-language pathologist and a radiologist. This allows them to see what’s happening in the throat when someone swallows different foods and liquids. It’s also how to know if certain things are being aspirated (going down “the wrong tube”), if there is residue in the throat after the swallow, and to figure out what strategies help with swallowing safety and efficiency.

• Fiberoptic Endoscopic Evaluation of Swallowing (FEES) — A trained speech-language pathologist passes a thin, flexible instrument through your nose in order to be able to gaze into your throat while you eat and drink. This is basically a top down view of swallowing, while a Modified Barium Swallow Study is a side view. It’s another way of viewing the anatomy and physiology of a person’s swallow. Like the Modified Barium Swallow Study, it can provide invaluable information on swallow safety, efficiency, and allows your clinician to then advise appropriate modifications and techniques to optimize or improve swallow function.

If swallow impairment relates to the esophagus (stomach tube), or if you require a feeding tube, you may be referred to work with a gastroenterologist for diagnostic tests or procedures. Another key member in your care team may be an otolaryngologist, who can diagnose and treat underlying pathologies of the mouth, throat, and neck. Bottom line? If you think you may have dysphagia, talk to your doctor so they can advise on referrals to the appropriate experts to help.

What can I do about it?

Speech-language pathologists can offer:

• Diagnostics — to help figure out the source of the problem

• Treatment — to restore function, or compensate for change(s) in function

• Recommendations — if indicated, speech-language pathologists can suggest potential diet modifications to liquids and/or solids to improve swallow safety or efficiency

• Education and counseling — information on treatment options, strategies to optimize quality of life, safety, and comfort with eating and drinking

• Referrals — refer you to other specialists, such as dietitians, gastroenterologists, otolaryngologists, etc.

Why does dysphagia matter?

Dysphagia matters because it effects how we eat and drink, and eating and drinking are essential parts of the human experience. Our social events and holidays revolve around it. Cultures are defined by practices related to food and drink. We use meals to punctuate our day. Eating and drinking provides pleasure and gratification, as well as nutrition and hydration. When our ability to safely or efficiently eat and drink by mouth is impacted, it can negatively impact life participation, quality of life, and — in some cases — increase risk of pulmonary complications, choking, and be associated with malnutrition/dehydration.