Swallowing disorders, also known as dysphagia, have been found to occur in five to 15 percent of the population. It is estimated that 15 million Americans have discomfort or difficulty swallowing.

Drinking a glass of water, or eating a delicious meal are simple, everyday activities that can give us great pleasure and at the same time be so automatic that we take them for granted. However, normal swallowing of food and liquid requires a great deal of coordination of a large number of muscles in the mouth, throat (pharynx) and esophagus.

Normal swallowing is safe because the larynx or entrance to the windpipe is closed as food passes. The food is normally moved efficiently through the mouth and throat with little trace of food left behind. When larger amounts of food are swallowed at a time, the swallow takes longer and the muscles of the mouth and throat work simultaneously. At times we hold our breath to protect the windpipe as we prepare to swallow. While normal swallowing may change at times depending on how much or what type of food is swallowed, the safety and efficiency of swallowing do not change.

Signs and symptoms of swallowing disorders include:

• Coughing or choking when eating or drinking
• Changes in voice quality when eating or drinking
• Food or liquid leaking from the mouth or getting stuck in the throat
• Extra time needed to eat or drink
• Recurrent pneumonia
• Weight loss
• Dehydration

Difficulty swallowing may eventually result in poor nutrition or dehydration and can lead to pneumonia or chronic lung disease.

What Causes Swallowing Disorders

Many diseases and medical conditions can affect the muscles involved in swallowing and our ability to swallow. Some of the more common include:

• Sudden, ongoing or progressive damage to the nervous system; such as with stroke, brain injury, spinal cord injury, cerebral palsy, muscular dystrophy, Parkinson’s disease, and Alzheimer’s disease.
• Problems affecting the head, neck, and mouth. These include injury or surgery affecting the head or neck, mouth or throat cancer.

Dysphagia can affect different phases of swallowing:

• Oral phase: difficulty chewing and moving food or liquid around in the mouth while preparing to swallow.
• Pharyngeal phase: difficulty triggering the swallowing and squeezing of food or liquid through the throat toward the esophagus while simultaneously closing the airway so nothing enters the windpipe and lungs.
• Esophageal phase: difficulty moving food through the esophagus toward the stomach through relaxation and tightening of some muscles in conjunction with a  squeezing action of other muscles.

How are Swallowing Disorders Diagnosed

Many medical specialists work together to evaluate and treat swallowing disorders. First, check with your physician who will be able to make appropriate referrals to specialists that can best diagnose your specific swallowing disorder and can individually design a treatment plan for you.

Swallowing Disorders Program

Our program at the Lancaster General Aquatic and Physical Rehab Center was developed to help diagnose dysphagia and develop a treatment program to maintain safe and efficient nutrition and help each individual eat, drink and enjoy mealtime as much as possible.

ASHA-certified speech-language pathologists perform swallowing evaluations and provide recommendations for treatment as appropriate. These services may include:

• Clinical examination of swallowing:  includes an interview to determine medical and swallowing history and tests to determine strength and movement of the muscles involved in oral phase of swallowing and need for further instrumental testing in the oral phase.
• Videofluorscopic swallowing study: also known as a modified barium swallow or video swallow study, a radiographic study or video x-ray which can diagnose oral, pharyngeal, and esophageal disorders of swallowing.

Can Swallowing Disorders Improve

Within the Swallowing Disorders Program at the Aquatic and Physical Rehab Center your treatment program will be individually determined based on the cause and type of dysphagia and swallowing symptoms identified. Treatment may include:

• Education about your specific type of dysphagia and the treatment program designed for you
• Exercises designed to strengthen or retrain muscles involved in swallowing
• Sensory stimulation: stimulation of various muscles with temperature or taste probes to increase reflexive response of muscles and nerves involved in swallowing
• Biofeedback or use of visual displays of the movement of swallowing muscles to help teach correct movements
• Electrical Stimulation: Vital Stim Therapy is a neuromuscular electrical stimulation that is FDA approved to treat dysphagia. It uses small electrical currents to stimulate the muscles responsible for swallowing.
• Recommendations of specific food and liquid consistencies or textures that are easier and safer for the individual to swallow

How Do I Get Help

If you are experiencing difficulty swallowing your doctor can make recommendations or referrals to help you as needed. For further information regarding the Swallowing Disorders Program contact us at (717) 544-3103.