Deglutition disorder (Dysphagia) includes problems passing of food from the oral cavity to the stomach. These problems may be because of delayed passage of the bite into the stomach, inhibition and escape to the trachea following a wrong path. If the food goes down to the level of vocal cords, it is called “penetration” and if it passes under vocal cords, it is called “aspiration”. Food reaching to the lungs during aspiration is a very dangerous and potentially fatal condition. Anyone can occasionally swallow what they eat as aspire, but a healthy person can cough as a reflex when the food goes into the trachea. However, people with reduced reflexes cannot understand that they are aspirating. This can sometimes lead to serious or even fatal problems. Deglutition disorder may occur due to neurogenic, mechanical, psychological and muscular diseases (myogenic) in any age group.
How Do We Swallow?
The swallowing function has four phases:
1) The period in which the first phase of food and beverages is chewed, mixed with saliva and made ready for swallowing.
2) The second period during which the formed food bite is pushed into the posterior part of the mouth during which the swallowing response begins.
3) In the pharynx phase, food and drinks are pushed into the upper esophageal valve. When this lid is opened, the food quickly passes from the pharynx to the esophagus.
4) In the last phase of the esophagus, food and drinks pass from the esophagus to the stomach. The first and second phases occur under voluntary control, while the third and fourth phases occur as reflexes.
What are the symptoms of swallowing difficulty?
- Long effort and time spent chewing and swallowing
- Coughing, vomiting during or after eating and drinking
- Wet, wheezing sound during or after eating and drinking
- Food leaking, spilling or accumulating in the mouth
- Inability to breathe after meal or having pneumonia
- Weight loss or dehydration development
What Causes Deglutition Diseases?
Unsuitable dentures, missing teeth, reduced saliva flow, esophageal or gastric entrance valve problems, stroke, progressive neurological disease (Parkinson, Multiple Sclerosis, Cerebral palsy, Alzheimer, Dementia), presence of tracheostomy tube, immobile vocal, mouth, Laryngeal or esophagus tumors and surgical operations performed on the head and neck region, radiation treatments or chemotherapy.
Who Evaluates Deglutition Diseases and How to Treat?
The ENT specialist, neurologist and language and speech therapist play a role in the treatment of swallowing disorder.
- Positions are chosen to strengthen the muscles responsible for swallowing and coordinated movements and exercises are performed in this position. This treatment is also called positional swallowing therapy.
- Customized exercises are performed with sensory stimulation techniques to stimulate the nerves that can activate the swallowing reflex.
- Dietary modification is made to determine the consistency that the patient can swallow without aspiration, to ensure safe swallowing without aspiration.