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Are you at risk?

Dysphagia can lead to many health problems, yet it’s an often under-diagnosed condition. Learning about the symptoms and risks is important when deciding whether you or your loved one should be screened.

What are the symptoms of dysphagia?

When an individual has trouble swallowing, it may show up in different ways. The following is a list of some of the signs and symptoms that are associated with dysphagia.

Physical signs:

  • Difficulty starting a swallow or needing several attempts to swallow a mouthful
  • Choking or coughing while eating or drinking
  • Food or drink going into the nose or windpipe
  • Food or drink leaking out of the mouth when eating or drinking
  • Troubles swallowing saliva, possibly leading to drooling
  • Significant amounts of food left in the mouth or throat after swallowing
  • Gurgly or wet-sounding voice after swallowing
  • Painful swallowing
  • Frequent chest infections or aspiration pneumonia
  • Weight loss related to eating and drinking less

Behavioural signs:

  • Sudden or gradual change in eating and drinking habits
  • Not wanting to eat
  • Avoiding certain foods and drinks
  • Taking a long time to eat or drink
  • Social Isolation and/or desire to eat alone

If you are in doubt, or if you spot any of these signs, you may wish to consult a healthcare professional.

Dysphagia can be screened, assessed or diagnosed in a number of different ways.

Below are some of the common ways that a healthcare professional may test for dysphagia. Keep in mind that the process used to assess your swallowing problems may vary depending on the healthcare professional you visit.

Testing for dysphagia may include both instrumental and non-instrumental methods, meaning they may or may not use special tools to check your swallowing.

Non-instrumental methods to assess for dysphagia

Commonly, a healthcare professional, such as a speech-language pathologist, dietitian or occupational therapist, may start by checking your medical history, including any past problems with swallowing or history of conditions that may lead to difficulties with swallowing.

Once the healthcare professional understands your medical history, they will often conduct physical and visual examinations. In a typical situation, your healthcare professional may ask you about your mental status, nutritional status, and your respiratory health. They may ask you to open and close your mouth, simulate a cough or move your lips or tongue in a certain way to check for your overall control of oral muscles and nerve function. They may also listen to the way you speak for any warning signs, such as gurgly voice caused by saliva entering the airway.

Your healthcare professional may give you a range of different liquids or foods to swallow, in varying amounts and thicknesses, to check your ability to swallow safely and efficiently. Not all food and drink items are swallowed the same way. You might have a problem with one consistency and no problems with anything else.

Instrumental examinations for dysphagia

In-depth examinations using clinical instruments may be performed by healthcare professionals with a more specialized knowledge of dysphagia. Typically, these tests go much deeper than non-instrumental tests and are used to explore a person’s swallowing symptoms in detail beyond simply checking for signs of aspiration.

Videofluoroscopic Swallowing Study (VFSS)

Also known as Modified Barium Swallow Study, is a widely-used instrumental examination method used to assess swallowing difficulties. It uses x-ray video to look at how you swallow, how well your swallowing is working, and where things may be going wrong. A swallow specialist uses this test to make sure that food or drink is not going down the wrong way, and is not being left behind in the mouth or throat after the swallow. These are things that cannot be determined through a non-instrumental method of assessment. In this test, you will be asked to eat a range of foods and drinks mixed with barium. The kind of barium used in swallow studies is white powder that is safe for most people, and the purpose of the barium is to clearly see where the food or liquid is in your mouth and throat during a swallow because barium can be seen on x-rays. This way, your healthcare professional can see how your swallow works in real swallowing situations. An appointment for this test normally takes about up to an hour from start to finish, and during this time you may be under the x-ray for about 5 minutes. You might notice that your stool turns white after a barium swallow study. This is normal. Ask your healthcare professional for additional details about this test, such as any risk factors associated with any other conditions you may have, such as pregnancy, or whether this test may be right for you.

Flexible Endoscopic Evaluation of Swallowing (FEES)

An alternative test to VFSS to look at swallowing function. This procedure involves a small endoscope (a thin, long tube with a camera at the end) being inserted into your throat through your nose. The camera is then used to help a swallow specialist watch your swallowing function. Similar to VFSS, you will be asked to swallow various foods and drinks while your healthcare professional watches the camera. Typically, this procedure is not painful, and your healthcare professional will apply lubrication, sometimes containing numbing agents, to minimize discomfort in your nostrils. This test is often performed at an ear, nose, and throat doctor’s office. Other swallowing specialists also perform this test. The procedure itself should only take a few minutes. Following either type of instrumental procedure, your swallow specialist should take time to view the results and discuss recommendations with you.

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What are the risks of dysphagia?

Dysphagia can be a serious medical condition and may impact your health and quality of life in a number of ways.

Malnutrition and dehydration

If you have swallowing difficulties, you may be at risk of not eating or drinking enough. This may lead to dehydration and malnutrition. Malnutrition and dehydration are serious problems that can lead to weight loss, weakness, increased risk of falls and a poor ability to fight infections. Ultimately, malnutrition and dehydration can result in frailty and weakness, potentially leading to the loss of a person’s independence.

Compromised quality of life

Eating and drinking often play a significant role in making life enjoyable. Not only are they a part of our day-to-day pleasures, but a large part of our social life, culture, and traditions centre around eating and drinking. It is no surprise that when someone suffers from dysphagia, it can significantly reduce the pleasure they get from eating and drinking their favourite things. In some cases, dysphagia may even lead to embarrassment, social isolation and depression, and place a person at further risk of malnutrition and dehydration. For these reasons, dysphagia may affect overall quality of life.

Respiratory problems

One of the most serious consequences of dysphagia is when the food or liquid goes down the wrong way, and into the airway. The medical term for this is “aspiration,” and it can lead to pneumonia or chest infections. Not everyone that “aspirates” food or liquid into their airway will develop pneumonia, however, there is a 50% risk of developing pneumonia depending upon the health of the individual. Also, aspiration pneumonia may carry up to 50% risk of death in certain individuals.

References: 1. Clavé P, Arreola V, Romea M, et al. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. Clinical Nutrition (Edinburgh, Scotland). 2008;27(6):806-15. 2. Clavé P, Terre R, de Kraa M, et al. Approaching oropharyngeal dysphagia. Revista espanola de enfermedades digestivas. 2004;96(2):119-31.

The need for tube feeding

In severe cases, an individual living with dysphagia may need to consider being fed through a feeding tube in order to be safely nourished. The decision to be fed using a feeding tube is a complex one, which requires a knowledge of all the risks and benefits. Your healthcare professional is your most reliable source of information about tube feedings.

Self-test questionnaire

EAT-10 is a list of 10 questions about your swallowing ability. This questionnaire can be completed in as little as 2 minutes and can assess your risk of dysphagia, and the need to see a swallowing specialist for further assessment. This questionnaire may be answered by the person with the swallowing difficulties alone or with the help of a caregiver or a healthcare professional. Complete the questionnaire here.

Nestlé Health Science has made every effort to include on this website only information that it believes to be accurate and reliable. Information provided on this site is for education purposes. It is not intended to replace the advice or instruction of your healthcare professionals, or to substitute medical care. Contact a qualified healthcare professional if you have questions or issues about what is best for you as you manage your swallowing difficulties at home.

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