Swallowing Problems

07/29/2011

Chewing and swallowing is far more complicated than most people realize. The sensory information provided by the food and liquid triggers activity in over 50 pairs of muscles to:

(1) prepare the material for swallowing

(2) move the material efficiently from the mouth into the esophagus then stomach

(3) protect the airway from food and liquid “going down the wrong way.’

All of this has to take place in a well choreographed pattern multiple times during a meal. Therefore, it is not surprising that some individuals with Parkinson’s Disease experience problems when swallowing called “dysphagia.”

Dysphagia can result in malnutrition and dehydration. Furthermore, when swallowing does not occur in a timely well-coordinated fashion, there is a risk that food can “go the wrong way.” This means that instead of going into the esophagus, the food can go into the airway and end up in the lungs. This misdirection of food is called aspiration, which can lead to severe medical complications such as pneumonia and airway blockage.

The warning signs of dysphagia include:

Slow eating and drinking resulting in malnutrition, weight loss, and dehydration
Choking or coughing when eating or drinking – these are signs of aspiration
Sensation of food getting stuck in throat
New difficulty swallowing pills
Occasional fevers – this may be a sign that the body is fighting infection which may result from chronic aspiration
Pneumonia

If you think you have a swallowing problem you should tell your doctor. They may send you for tests to determine whether you have dysphagia. A Speech Language Pathologist (SLP) conducts these tests because the swallowing musculature is essentially the same as voice and speech musculature. The SLP may evaluate your swallowing in a number of ways including:

Video Fluoroscopic Swallow Study (VFSS) also called a Modified Barium Swallow Study (MBSS) –This is a video x-ray of your swallowing function
Flexible Endoscopic Swallow Study (FEES) – and endoscope is used to visualize the inside of the throat as you eat and drink

If dysphagia is present, your SLP may recommend:

Therapy to strengthen certain muscles
Protective postures and/or dietary modifications to protect the airway during meals and improve efficient direction of food into the esophagus

Remember, general recommendations for safe swallowing include:

Taking small bites and sips at a sensible rate
Moisten food or avoid dry difficult to swallow foods
Minimizing distractions during meals such as TV and radio
Limiting talking during meals

Online resources for dysphagia:

National Institutes of Health (NIH) http://www.nidcd.nih.gov/health/voice/dysph.html
Medline Plus http://www.nlm.nih.gov/medlineplus/swallowingdisorders.html
WebMD http://www.webmd.com/digestive-disorders/tc/difficulty-swallowing-dysphagia-overview
American Speech-Language-Hearing Association (ASHA) http://www.asha.org/public/speech/swallowing/SwallowingAdults.htm
UW Medicine http://uwmedicine.washington.edu/Patient-Care/Our-Services/Find-a-Clinic/Pages/clinic.aspx?clinicid=477

[See related article on Drooling.]

Author: Yumi Sumida, MFA MS CCC-SLP, Univ of Washington

Copyright 2011 Northwest Parkinson's Foundation Wellness Center

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