Dysphagia can be extremely hard to cope with because it affects
            something people do hundreds of times a day,  SWALLOW!

              Because there are many possible causes of dysphagia, symptoms vary
            widely among individuals.  For example, one person may have mild throat
            discomfort when swallowing, while another may be unable to eat any solid
            foods comfortably.  Dysphagia can be caused by many factors, most of
            which are non-threatening and temporary.

Aspiration: food or liquids getting into the lungs
 

Bolus: the rounded mass of food prepared to swallow
 

Esophagus:  passage way from the pharynx to the stomach
 

Larynx:  the "voice box", structure between pharynx and trachea that houses the vocal folds, essential in voice production
 

Palate:  a partition separating the nasal and oral cavities
 

Penetration: if any food enters into your airway area while swallowing
 

Pharynx:  the back of the throat; passage between the larynx and the esophagus
 

    Trachea:  windpipe leading into the lungs
 
 
 

        1.  Modified Barium Swallow Evaluation:  The patients moving x-ray is recorded onto a videotape
         during several swallows using different consistencies of food.  It shows an actual x-ray
         image of the internal structures involved in swallowing, and also of the actual material being
         swallowed.
 

        2.  Fiberoptic Endoscopic Evaluation of Swallowing (FEES):  A flexible tube is  passed through
         the person's nose and into the throat so that eating can be viewed directly.
 
 

The professionals you might meet:

                                                                                                       
 

                 Because a multitude of medical conditions can produce similiar symptoms of dysphagia,
           patients with swallowing disorders are best served by a team of specialists, which may be:
 

                1.  A Speech Language Pathologist (SLP):
                                The SLP helps the patient learn how to compensate for his/ her swallowing
                    problems, recommending various exercises, positions, or strategies to help swallow
                    more effectively.
                                A primary goal for the SLP is to have the patient be able to ingest foods and
                    liquids safely.

                2. An Otolaryngologist (ENT):
                                The ENT examines the mouth and throat.  This may be done using mirrors or
                     small tube inserted into throat which provides vision of the back of the tongue, throat,
                     and the larynx.

                3. An Occupational Therapist (OT) and/or a Physical Therapist (PT):
                                An OT or PT can aid the patient and family in feeding techniques, thus helping the
                     patient become as independent as possible.

                4.  A Nutritionist:
                                A nutritionist can determine the amount of food or liquid necessary to sustain
                    a normal diet and decides whether or not supplements are necessary.  It is important
                    for the patient to receive proper hydration, nourishment, and gratification from his/her
                    food intake however, these must be balanced by a caution for aspiration and choking.

                5. A Gastroenterologist:
                                  The Gastroenterologist is a physician who specializes in treating problems of the
                     digestive system.  Dysphagia is related to problems of the digestive system due to
                     GastroEsophageal Reflux Disease (GERD) in which acids from the stomach push back up
                     the esophagus, resulting in pain and discomfort when swallowing.
 
 

Intervention

        1. Medication
                        This may include drugs that slow stomach acid production, muscle relaxants, and/or
                    antacids (mainly used for Gastroesophageal Reflux disease).

                2. Swallowing Therapy
                         Therapist may suggest safe swallowing techniques, compensatory techniques, or
                     changes in body positioning.

                3. Surgery
                         Surgical treamtents depend on the location of the swallowing disorder.  Some options
                      include cutting a muscle to dialate a narrow area, strengthening or loosening the upper
                      or lower esophageal valves, or perhaps the removal of a tumor from the esophagus.

                4. Changes in Diet
                         Consume foods and liquids of a pureed or pudding texture to reduce the risk of food
                      going into the trachea or windpipe. (This website is helpful for dietary advice!)
 
 

What can you do to help?

        1. Make sure that their head position and posture when swallowing is what your Speech Language
         Pathologist (SLP) or Doctor recommended (usually chin to chest is best).

        2. Help them to remember to swallow all of the food in their mouth before taking another bite.
         They also may need to take an extra swallow to make sure all of the food is cleared out of their
         throat.

        3. Eating smaller, more frequent meals is sometimes helpful.

        4. Remember that thickened liquids are generally easier to swallow, try adding yogurt to most
         foods.

        5. They should avoid eating when they are extremely tired.

        6. You can help them with exercises to strengthen their mouth and throat, that your SLP or
         doctor recommends.

        7. Prepare the recommended textures of food and liquid, making sure that recommendations for
         eating safely are followed (TRY THIS WEBSITE FOR TIPS).

        8. Keep track of how much food and liquid has been consumed.

        9. Try a pinch of meat tenderizer on the tongue if suffering from a dry mouth-  it acts like a
         natural moisturizer.
 
 

Links to other Helpful Websites

         www.dysphagia.com

         www.dysphagia-diet.com/webtext1.htm

         www.stjosephs.org/iv_k_6.htm

         www.hormelhealthlabs.com/dysphagia/index.htm

         healthlink.mcw.edu/article/914645127.html

         www.bcm.tmc.edu/oto/studs/speech.html
 

          References:
 

            American Academy of Otolaryngology- Head and Neck Surgery.  Public Service Brochure located at
                            www.sinuscarecenter.com

           Comprehensive management of swallowing disorders / San Diego : Singular Pub. Group, c1999.

           Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients / [Rockville,
                  MD] : AHCPR Publication, [1999]

           Dysphagia : diagnosis and management / 3rd ed. Boston : Butterworth-Heinemann, c1997.

           Dysphagia (swallowing disorders) : a manual for use by families, under the direction of a speech-language
                  pathologist / Danville, IL : Interstate Printers and Publishers, Inc., c1987.

           Murray, Joseph, 1958- Manual of dysphagia assessment in adults / San Diego : Singular Pub. Group,
                  c1999.

           Posner, Trudy E. Dysphagia resource manual : training for caregivers of patients with swallowing
                  problems / Rockville, MD : American Occupational Therapy Association, c1991.

                                                       Last Updated: 12/04/2001    By: Sethley Branan and Leslie Weaver