Published on June 11, 2021

The Hard-to-Swallow Truth

people eating and drinking

About one in every 25 U.S. adults is affected by dysphagia, the medical term for difficulty swallowing. Two terms that are used with dysphagia are:

  • Aspiration, which means that food and liquid are going into the windpipe instead of into the stomach.
  • Penetration, which means that food or liquid briefly go into the upper part of the airway and may or may not clear with another swallow or throat clear.

Dysphagia is a symptom or result of many different disease processes and not a disease on its own. Dysphagia can be caused by stroke, head injury, neurological diseases like dementia and Parkinson’s disease, trauma and surgery, to name a few.

Common signs of dysphagia are:

  • Pain while swallowing
  • Inability to swallow
  • Feeling like something is stuck
  • Regurgitation – or food and liquids coming back up soon after swallowing them
  • Frequent coughing while eating and drinking
  • Frequent choking episodes

Consequences of dysphagia include:

  • Aspiration pneumonia
  • Malnutrition
  • Weight loss
  • Dehydration
  • Depression
  • Decreased quality of life

Things the speech pathologist may recommend to treat dysphagia:

  • Swallow strengthening exercises (these exercises will vary depending on what is causing the dysphagia)
  • Compensatory strategies or postures (putting the chin down when drinking, turning the head to the left before swallowing)
  • Modified diets (chopped, minced or pureed foods)
  • Thickened liquids

Common misconceptions about dysphagia:

  • A chin tuck will keep someone from aspirating (food going down the wrong “pipe”)—FALSE.
    A chin tuck can help some people swallow safely; however, research has shown that it is not effective in everyone. In order to truly know if a chin tuck will keep someone from aspirating, it needs to be tested during an instrumental exam. In fact, some studies have shown that chin tucks can make the problem worse.
  • Everyone with dysphagia needs thickened liquids—FALSE.
    Some people with dysphagia may benefit from thickened liquids while some may not. Health care professionals use thickened liquids to promote safe swallowing. However, research has shown that thickened liquids often just suppress the cough without decreasing aspiration. Thickened liquids can also lead to dehydration if patients don’t drink them. The need for thickened liquids should be determined during the instrumental swallow exam.
  • Aspiration will always lead to aspiration pneumonia – FALSE.
    It was long assumed by health care professionals that aspiration was a deadly event and should be avoided at all costs. We know now that aspiration alone does not equal adverse events. There are many factors to consider when determining if a patient may be at risk for aspiration pneumonia, such as how frail or sick the patient is, what his immune system is like, how many other illnesses he has, the number of medications he takes and the condition of his mouth. Studies have shown that good oral care—brushing teeth and tongue with a brush and toothpaste—is an excellent defense against pneumonia.
  • People with feeding tubes can’t aspirate – FALSE.
    Unfortunately, aspiration of saliva is a significant concern for people who are on feeding tubes with significant risk of aspiration. There is also a risk of aspirating reflux that can be caused by the presence of the tube itself.
  • Coughing during a meal always means the person is aspirating – FALSE.
    Coughing during a meal can mean a number of things. Esophageal reflux (GERD) can cause coughing during a meal or immediately after. You could be coughing because you have a cold, allergies or bronchitis. Some medications cause chronic cough. To determine if the cough is caused by dysphagia, the person should be evaluated by a speech pathologist.

About one in every 25 U.S. adults is affected by dysphagia, the medical term for difficulty swallowing.