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Dysphagia
What is a "normal swallow?"

Normal swallowing is rapid, safe, and efficient and requires less than two seconds to complete. Normal swallowing of food and liquid requires coordination of a large number of muscles in the mouth, throat (pharynx), and esophagus (the tube connecting the pharynx to the stomach).

The swallow begins as the tongue pushes the food upward and backward toward the rear of the mouth and throat. As this occurs, muscles in the pharynx begin to move to receive the food. The top of the larynx begins to lift, move forward, and close, to prevent food from going into the lungs (aspiration). The soft part of the roof of the mouth (soft palate or velum) lifts to close off to the nasal cavity.

As food and liquid enter the rear of the phayrnx, the pharyngeal muscles contract to squeeze the food through the pharynx and into the esophagus. As food approaches the entrance to the esophagus, the valve at the top of the esophagus opens to allow the food to pass. In turn, muscles in the esophagus contract to push the food from the top of the esophagus through the valve and into the stomach.

What causes a swallowing problem?

Because many anatomic components (pharynx, tongue, larynx, esophagus) are involved in swallowing, dysphagia has many possible causes. The problem may usually be distinguished as having either a mechanical or neural etiology (cause). In rare cases, the etiology remains idopathic (unknown).

Among the more common reasons for swallowing problems are sudden onset neurologic damage (e.g., stroke, head injury, or spinal injury), progressive neurologic disease (e.g., Parkinson's disease, motor neuron disease, multiple sclerosis, myasthenia gravis), head and neck tumors and their treatment, medical problems such as rheumatoid arthritis, scleroderma, and diabetes, or induced trauma to the esophagus, larynx, tongue, or pharynx.

What are the most common signs a swallowing problem exists?

Indications of dysphagia include:

  • Coughing while eating or drinking or very soon after eating or drinking
  • "Wet sounding" voice during or after eating
  • Increased congestion in the chest after eating or drinking
  • Slow eating
  • Multiple swallows on a single mouthful of food
  • Obvious extra effort or difficulty while chewing or swallowing
  • Fatigue or shortness of breath while eating
  • Temperature rise 30 minutes to an hour after eating
  • Weight loss associated with increased slowness in eating
  • Repetitive pneumonias

If any of these signs or symptoms are noted, the person should be given a complete medical examination by a physician and also be evaluated by a swallowing specialist (usually a speech-language pathologist). As noted above, dysphagia may indicate the presence of an underlying neurologic disorder, in which early treatment may be essential for proper management.

How many people in clinical environments are affected by swallowing problems?

Dysphagia has been found to occur in approximately 13-14 percent of all hospitalized patients, 40-50 percent of patients in nursing homes, and approximately 33 percent of the patients in rehabilitation centers.

Patients must consult with an otolaryngologist who specializes in dysphagia before swallowing therapy or a remediation plan may be undertaken by the Dysphagia Service. If you wish to inquire about dysphagia services, please call 212-979-4340 for a medical referral or to receive additional information.

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