Swallowing Difficulties

Swallowing is an important everyday function for eating and drinking. Swallowing difficulties is also known as dysphagia. People who experience dysphagia include:

• People who have had a stroke or head injury
• People who have had head & neck tumours and had head & neck surgery
• People who have had recent critical illnesses and are frail or deconditioned

• Coughing during eating and drinking or shortly after eating / drinking
• A wet / gurgly voice during or after eating / drinking
• A tendency to hold food or drink in the mouth for prolonged periods of time
• Difficulty eating hard, chewy or crumbly foods
• Shortness of breath induced by eating or drinking
• Taking more than 30 minutes to finish a meal
• Drooling of saliva or inability to swallow saliva
• Refusal to eat
• Unexpected and unexplained loss of weight because of a prolonged eating time, poor appetite, or avoidance of certain foods
• Recurrent chest infections or pneumonia

The Speech Therapist will take a case history of your swallowing difficulties and first assess your swallowing in the clinic via a clinical examination. The therapist may proceed to recommend further swallowing imaging studies, such as:

• Videofluoroscopy Swallowing Study (VFSS)
• FEES (Flexible Endoscopic Evaluation of Swallowing)

Videofluoroscopy Swallowing Study (VFSS)

• It is a swallowing assessment using X-ray imaging so that we can see your swallowing movements as you eat and swallow food and liquids.
• You will be asked to eat small amounts of food and liquids, mixed with a contrast called barium sulphate. This allows the speech therapist to see the food and liquids on the X-ray image.
• The examination will be video recorded so that the speech therapist can further analyse your swallowing function.

FEES (Flexible Endoscopic Evaluation of Swallowing)

• This is a swallowing examination using a flexible endoscope.
• The scope is inserted through your nose to your throat. The camera within the scope allows the speech therapist to see the swallowing movements as you eat and drink.
• You will be given some food and liquids mixed with food colouring to eat/drink so that we can assess your swallowing.
• This examination is also recorded so that the speech therapist can further analyse your swallowing function.

Based on the results of the swallowing assessments (clinical or imaging), the therapist will have more information to:

• Suggest why you are having swallowing problems.
• Advise you on safe and appropriate food textures and liquid consistencies to swallow.
• Recommend swallowing postures and strategies that may help you swallow with more ease.
• Plan swallowing exercises or programs for you.
• Advise whether you may need alternative methods of feeding (e.g. tube feeding).

How can swallowing exercises help?

• Swallowing exercises (such as lip and tongue exercises) can help to strengthen the muscles for chewing and managing food and drink. They can also help you to time your swallow better. Eventually, the ability to finish a meal safely and timely may be achieved.
• You may also be taught to do some swallowing postures (such as head tilts and turns, chin tuck) which may help you to swallow more safely.

How can thickened liquids help?

Thickened liquids are liquids which are thickened to different consistencies with a starch or gum-based powder. You may be advised to thicken your liquids because you choke or cough on thin liquids.

If you have dysphagia, your swallowing muscles may not react fast enough to swallow thin liquids. Some of it may enter your airway (aspiration), causing you to cough. By thickening liquids, it flows more slowly through your mouth and throat when you swallow. Hence, this reduces the likelihood that liquids will enter your airway and reduce the coughing episodes.

What is Aspiration?

Aspiration is the entry of food or liquid into your airway. If food or liquid enters your airway, the normal response is to cough. Some medical conditions may result in people not coughing when food or liquid goes into their airway – this is then known as silent aspiration.

Why might you need a feeding tube?

If you have severe dysphagia which makes it unsafe and inefficient to eat or drink normally through your mouth, you may need a feeding tube.

There are different types of feeding tubes. These can generally be divided into 2 groups:

• Naso-Gastric tube (N.G.T)
• P.E.G (Percutaneous Endoscopic Gastrostomy)

An N.G.T is inserted via the nose, down the oesophagus (food pipe), and into the stomach.

A P.E.G is inserted directly into the stomach via a small incision in the stomach wall.

Oral nutritional supplements are fed via the feeding tubes to meet your specific needs. Always follow the instructions given to you by the medical staff with regard to the amount of nutritional drinks required.