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Swallowing problems: Dysphagia

  • What is dysphagia?

    Dysphagia (dis-FAY-ja) is a swallowing problem. This problem may be caused by weakness or loss of feeling in your tongue, lips, palate and/or throat. You may notice:

    • food moving around your mouth
    • food sticking in your throat
    • coughing or choking on liquids or solids.

    What causes swallowing problems?

    Your swallowing problems may be caused by:

    • stroke
    • head injury
    • disorder such as multiple sclerosis or Parkinson's disease
    • cancer in the mouth, throat or esophagus
    • injury or surgery to the head or neck
    • recent intubation (a breathing tube placed in your throat)
    • decline in overall strength.

    How will your swallowing problems be found?

    A doctor or speech-language pathologist (SLP) can determine if you have swallowing problems. There are many tests that can confirm if you have dysphagia:

    • swallowing evaluation. The SLP watches you eat foods and drink liquids. This will help him or her tell if other tests are needed.
    • fiberoptic endoscopic evaluation of swallowing. The doctor or SLP inserts a thin flexible scope into your nose. A tiny camera at the end of the scope lets him or her watch as you swallow foods and liquids. (This test is known as FEES.)
    • video swallow study. You will swallow small amounts of barium (a white liquid that shows up on X-ray) to simulate "normal" eating. A video is taken as you swallow the barium. Your doctor or SLP can study your ability to chew and swallow and to check for aspiration.

    Together, you, your health care provider and your speech-language pathologist will choose the test that's right for you.

    What is aspiration?

    Aspiration occurs when food or liquid goes down your windpipe (trachea). It can sometimes lead to pneumonia (infection or swelling of your lungs).

    Signs of aspiration include:

    • coughing during or right after eating or drinking
    • a wet-sounding voice
    • noisy breathing
    • shortness of breath
    • pneumonia that won't go away
    • rattle sound in your lungs.

    Aspiration can cause pneumonia. Signs of pneumonia are:

    • fever
    • rattle sound in your lungs
    • rapid breathing
    • chills
    • cough with mucus
    • chest pain
    • feeling drowsy or not as alert.

    Call your doctor right away if you are having shortness of breath or fever.

    What causes choking or coughing?

    Choking and coughing are reflexes. They are caused by your body's instinct to protect itself from food or liquid going down your windpipe (trachea) and into your lungs.

    Choking and coughing can be scary because they can be caused by serious problems. You can reduce your risk of choking. Here are some things you can do:

    • Watch for signs of aspiration (listed above).
    • Check with your doctor or speech-language pathologist if you cough when you swallow.
    • Don't try to stop a cough. A cough is your body's natural protection against choking.
    • Stop eating if you can't stop coughing or if you can't clear your airway. If this happens, call 911 right away.

    What can be done to help your swallowing?

    The speech-language pathologist may recommend one or more of the following to make swallowing safer:

    • body and head positions
    • changed food textures
    • smaller meals eaten more often
    • special feeding utensils and containers
    • exercises to strengthen your swallow
    • electrical stimulation to improve your swallow. (Patches are placed on your neck. A machine sends electrical impulses to help make your swallowing muscles stronger.)

    You and your caregiver may also work with a dietitian, occupational therapist and nursing staff during swallowing treatment and recovery.

    If your swallow is too weak or unsafe, you may need to get your nutrients by a tube. A feeding tube is passed through your nose and esophagus to your stomach. This will be used for short-term tube feedings.

    If your recovery is slow, a gastrostomy tube is put through your abdominal wall into your stomach. This will be used for long-term tube feedings.

    When can you swallow again?

    Your ability to swallow may improve during recovery. As your swallow improves, changes may be made to your diet, exercises or swallowing techniques. This speech-language pathologist will give you updates on your progress.