Dysphagia (Swallowing Difficulty)

The causes of dysphagia vary, some of the most common causes are head and neck cancers (including side-effects from radiotherapy), neurological diseases (stroke, Alzheimer’s, Parkinson’s) or Zenker’s diverticulum.

Some people have dysphagia short-term because of sudden weakness from a flare-up of an unrelated problem, such as flu or kidney disease. Others may have more long-term swallowing problems.

• Not being able to swallow
• Coughing or gagging while swallowing
• Experiencing pain when swallowing
• Feeling that food is stuck in the throat or chest or behind the sternum
• Undigested food coming back up (regurgitation)
• Extra effort needed to chew or swallow
• A wet or gurgly sound

• Loss of weight
• Dehydration
• Malnutrition
• Aspiration pneumonia (chest infection)

Your speech therapist or doctor may recommend a specialised swallowing test to better understand the problem.

It can be a videofluoroscopy (X-ray) or a small camera (fibreoptic endoscopic evaluation of swallowing, also known as FEES) that goes in the nose. Both tests are used to determine what may be causing the swallowing problem and strategies that can be used to address it during therapy.

The management of dysphagia depends on the underlying cause. Swallowing therapy may help to improve the dysphagia. In some cases, such as Zenker’s diverticulum or cricopharyngeal stenosis, surgery by an ENT doctor is part of the management. 

• Diet texture changes, such as thickening liquids or pureeing food
• Swallowing exercises to improve strength and coordination
• Compensatory strategies or head positions to make swallowing safer and easier

Ensure the follow during and after feeding:

• Patient is alert and sitting upright
• Minimise distractions
• Observe the person and feed the next spoonful only after you have seen him/her swallow
• Allow plenty of time for meals
• Do not encourage the person to eat and talk at the same time
• Allow the person to rest if he/she appears short of breath
• Allow the person to remain seated 45 mins after a meal
• Stop if the person appears tired

Points to note:
It is important to discontinue feeding completely if the person is coughing excessively during meals. Please alert your speech therapist and consider bringing forward any existing speech therapist outpatient appointment.

Please seek medical attention at the earliest possible time if symptoms of chest infection (e.g., persistent cough, fever, thick yellow/green phlegm) are observed.

Ms Raynor Sharon Nicola

Senior Speech Therapist