Do You Have Difficulty in SWALLOWING?
Mangaluru: Every year, the month of June is observed as “Dysphagia awareness” month. In this regard, the Department of Speech and Hearing at the Father Muller College brings the awareness of Dysphagia to the masses which may help in early identification, assessment and prompt management of the disorder.
What is Dysphagia?
The disorder of swallowing is commonly referred to as ‘Dysphagia’. It is a condition where a person experiences difficulty in swallowing any solid or liquid food or both. Though India still lacks precise epidemiological data on Dysphagia, several western studies have reported an incidence of 3 to 30% in the adults and the elderly. With poor lifestyle choices and a concomitant increase in stroke, the risk of inviting Dysphagia is high. Roughly one third of all the individuals with Stroke experiences Dysphagia at some point of time. With varying etiologies, Dysphagia could occur in Paediatric, Adult and Geriatric populations. While emphasizing its seriousness and its consequences on psycho-social health, WHO has prioritized the early identification protocols, and strengthened the management options for patients with Dysphagia.
How do we swallow?
In simple terms, any intake of food reaches the stomach in 3 phases. In the 1st phase, the food is chewed and mixed with saliva (called ‘bolus’) and moved voluntarily to the back of the oral cavity. In the second phase, food is involuntarily moved into the food pipe (oesophagus) through pharynx. The food finally reaches the stomach through a food pipe which is termed as‘ oesophageal phase’.
What causes Dysphagia?
In pediatric population, swallowing impairment is commonly observed secondary to structural abnormalities (e.g., Cleft Lip/Palate), neuromotor weakness (e.g., Cerebral Palsy, Meningitis), syndromic conditions (e.g., Down Syndrome and Treacher Collins syndrome), Poor general health (e.g., Congenital Heart or Pulmonary issues), Developmental disabilities, Behavioural and Psychosocial issues (poor interaction with the caregiver). In adults, it commonly occurs due to neurological problems that affect any of the above phases of swallowing. Weakness and incoordination of the oral muscles secondary to trauma, infection, acute neurological events (e.g., Stroke) and progressive neurological diseases impairs the swallowing function in adults.
What are the signs & symptoms?
Drooling (oozing of saliva from mouth), longer time taken for chewing/swallowing, nasal leakage of the food/liquid (nasal regurgitation), painful sensation while swallowing, change in voice after eating/drinking, recurrent coughing during/after food intake, unexplained weight loss, aversion to certain foods, feeling like lump in the throat, and (or) accumulation of saliva in the oral cavity are some of the clinical signs associated with Dysphagia.
In severe cases of Dysphagia, airway management and supply of adequate nutrition becomes the primary goal of intervention. Sometimes this condition goes unnoticed because the individual might not feel any pain or does not choke even when food enters the windpipe. This induces complications of lung infections and causes troubled breathing leading to emergency hospitalization. It is always advised to reach for prompt medical help in case of swallowing difficulties so that further complications could be easily averted.
Whom to contact? Is there any treatment available for this condition?
The primary management team includes a Neurologist, Speech-Language Pathologist, and Otolaryngologist. Commonly, Speech-Language Pathologists (SLPs) spearhead the team of professionals who perform screening and diagnostic formulation of the swallowing using behavioural checklists and mealtime observation of patients’ clinical signs for various food consistencies (Solid vs. Semi-solid vs. Liquid). Behavioural observation is further augmented by Instrumental analysis, such as Videofluoroscopy and Flexible Endoscopic Evaluation of Swallowing (FEES). Detailed therapeutic plans are formed after the assessment and behavioural intervention of swallowing is facilitated wherein patients are made to learn swallowing exercises and manoeuvres along with postural modifications and changes to the dietary habits which together restore the swallowing function. In the Department of Speech and Hearing, Father Muller College, we have a group of well trained SLPs, who in coordination with other departments, assess swallowing functions and deliver treatment for individuals with Dysphagia.
Indian traditions have closely associated itself with a variety of cuisines that goes along well with changing geographical boundaries and seasons. If cherishing food becomes difficult, so does the quality of life. ‘Let thy food be thy medicine and thy medicine be thy food’-with this, we appeal to the readers to spread awareness on Dysphagia.
Dr Mahesh B.V.M. Associate Professor in Speech-Language Pathology, Department of Speech and Hearing, Father Muller College of Speech and Hearing, Mangaluru.