Dysphagia and Swallowing Jan Adams, DNP, MPA, RN and Karen Kern
Scope of the Problem and Incidence 15 million people in the US have some form of Dysphagia. Every year, 1 million people are diagnosed with Dysphagia. Every year 60,000 individuals die from various complications caused by swallowing disorders. 25%-70% of stroke patients experience swallowing difficulties.
What is Dysphagia? The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. (AAO-HNS, 2016).
Causes of Dysphagia There are two main classes of problems that can lead to swallowing disorders: 1. Neuromuscular problems: Weaken muscles (stroke) 2. Narrowing of the throat or esophagus: throat cancer, esophageal cancer and other conditions that make the esophagus narrower.
Causes of Dysphagia Adult Causes Aging Malfunction of throat, esophagus, or mouth muscles Infections that cause narrowing of the esophagus Nerve or brain condition affecting muscle coordination Chest, neck, or head injuries
Causes of Dysphagia Pediatric Causes Premature or low birth weight Nervous System Disorders Cleft Lip or Palate
Four Stages of Swallowing The first stage is the oral preparation stage, where food or liquid is manipulated and chewed in preparation for swallowing. The second stage is the oral stage, where the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
Stages of Swallowing (Con t) The third stage is the pharyngeal stage which begins as food or liquid is quickly passed through the pharynx, the region of the throat which connects the mouth with the esophagus, then into the esophagus or swallowing tube. In the final stage, esophageal stage, the food or liquid passes through the esophagus into the stomach. The first and second stages have some voluntary control, stages three and four occur involuntarily, without conscious input.
Anatomy of Swallowing
Mechanics of Swallowing Video https://youtu.be/pncv6yafq-g
Swallowing Videofluoroscopy https://youtu.be/ri8bbhw9msq Videofluoroscopic swallow study (VFSS). (Barium is given in different consistencies of food and an x-ray movie of swallowing is taken to view narrowing or changes).
Adult Symptoms of Dysphagia 1) Difficulty or Pain in swallowing 2) Excessive Drooling 3) Difficulty in chewing/preparing the bolus 4) Choking 5) Regurgitation 6) Excessive Throat Clearing 7) Hoarse Voice 8) Frequent Heartburn 9) Unexpected Weight Loss
Pediatric Symptoms of Dysphagia 1) Tension in the body while feeding 2) Poor weight gain and growth 3) Food or liquid leaking from the mouth 4) Vomiting during feeding or meals 5) Refuse to eat foods possessing certain textures.
ENT Evaluation of Swallowing MD Anderson Dysphagia Inventory (MDADI) A Self-administered questionnaire designed specifically for evaluating the impact of dysphagia on the QOL of patients with H&N cancer. It is composed of 20 questions. Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Archives of Otolaryngoly Head Neck Surg 2001;127:870-6.
Treatments Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.
Treatments (Con t) Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder. Once the cause is determined, swallowing disorders may be treated with: Medication Thickened liquids and diet modification swallowing study and/or therapy Surgery (VC Medialization or Myotomy) Botox therapy Source: http://www.entnet.org/content/swallowing-trouble
Dysphagia in the Elderly Occurs in 10-30% of elderly patients Causes include connective tissue disease, disorders of the oropharynx, hypopharynx, or esophagus, autoimmune disease, CV, and Neurologic Disorders Medications can lead to dysphagia. Such as anticholinergics, antidepressants, antihypertensives, and phenothiazides. Major complications is pneumonia.
Swallowing Swallowing, or deglutition, is the process by which food passes from the mouth, through the pharynx and into the esophagus. As simple as it might seem to healthy people, swallowing is actually a very complex action that requires an extremely precise coordination with breathing since both of these processes share the same entrance: the pharynx. Failure to coordinate would result in choking or aspiration. Swallowing involves over twenty muscles of the mouth, throat and esophagus that are controlled by several cortical areas of the brain. The brain communicates with the muscles through several cranial nerves.