Difficulty Swallowing? A Speech-Language Pathologist Can Help

Much like breathing, swallowing is one of those things you do all day, every day—even in your sleep—without much thought. And much like breathing, swallowing is essential to good health. It’s what allows you to stay hydrated and nourished and it’s what propels saliva from your mouth to your stomach. It’s no wonder that difficulties with swallowing can lead to serious health complications. The good news for many is that issues with swallowing can often be resolved or improved by working with a trained speech-language pathologist. That’s right, a speech-language pathologist (more on that later).

The first challenge in addressing swallowing difficulty, or dysphagia as it’s referred to in medical circles, is understanding what the issue is and what’s causing it.

Dysphagia can include problems with sucking, swallowing, drinking, chewing, eating, controlling saliva, taking medication, or protecting the lungs from food and drink ‘going down the wrong way.’ It can also include issues with keeping your lips closed so that food, liquid or saliva doesn’t dribble out. Coughing, throat clearing, choking, watery eyes, runny nose and/or feeling something is caught in the throat can be symptoms of dysphagia. 

Common causes of dysphagia include brain injury, stroke, dementia, neurological disorders such as Parkinson’s Disease and ALS, trauma to the throat, head and neck cancer, radiation, lymphedema, tooth loss, acid reflux, and even being of an advanced age.

Untreated, dysphagia can lead to dehydration and malnutrition. It can also increase the risk of choking, aspiration (accidentally taking food or fluid into the lungs or airway), and respiratory infections which can lead to hospitalizations and additional health consequences. And, of course, because eating is often a social activity, difficulty swallowing can greatly impact someone’s quality of life as they may choose to avoid eating with family and friends or dining in public.

Here’s where a speech-language pathologist (SLP) comes in.

SLPs are the preferred providers for dysphagia services and have extensive knowledge of the muscles of the mouth and the throat and how they work for speech, voice, and swallowing.

An SLP’s work with patients begins with an evaluation to assess what’s taking place in the patient’s mouth and throat during the swallow. This includes a patient interview, physical examination of the mouth and throat, and observation of the patient consuming different liquids and foods. In some instances, imaging may be used to provide a complete picture of the deficits to help guide treatment approaches. SLPs can also recognize signs and symptoms of esophageal dysphagia and make appropriate referrals for its diagnosis and treatment. Based on the findings, the SLP will develop an individualized treatment plan. What’s included in the plan varies based on the type and severity of dysphagia as well as the patient’s goals of care.

In some cases, the goal is restoration, which involves strategies for strengthening the muscles used for swallowing. For others, the focus may be learning ways to manage dysphagia with the use of safe swallowing strategies or food consistency modifications. Another possible goal may be to maintain current swallowing function in order to prevent further decline. 

Typically, sessions with an SLP last 30 to 60 minutes and may include specialized exercises, massage of the throat, neuromuscular electrical stimulation, instruction in techniques for safer eating and drinking, supportive counseling, and caregiver education. Patients may also be provided with a home exercise program. The number and frequency of sessions are determined on an individual basis. Treatment plans are frequently adjusted to keep pace with patient progress or changing goals.

If you have questions or concerns about swallowing, contact SVMC to schedule an evaluation. SLPs are available at clinic locations in Bennington,  Manchester, Wilmington, and at the Southwestern Vermont Regional Cancer Center.

Kate O'Neill, MS, CCC-SLP, is a speech-language pathologist at SVMC Outpatient Rehabilitation, part of Southwestern Vermont Medical Center.