Swallowing is a complex process involving various muscles and nerves. When it is disrupted, disorders can occur, affecting the ability to swallow. These dysfunctions are characterized by symptoms such as coughing while eating, the sensation of a blockage in the throat, or pain when swallowing. Various causes can be behind these disorders, ranging from neurodegenerative diseases to physical obstructions or infections. Managing these disorders is essential to maintain adequate nutrition and prevent complications, and may include rehabilitation exercises, dietary modifications, or even surgical interventions if necessary.
Understanding swallowing disorders: symptoms and alerts
Dysphagia: This medical term refers to difficulties in swallowing, a phenomenon more common than one might think. Symptoms vary depending on the type of dysphagia: oropharyngeal or esophageal. They include pain or discomfort during swallowing, the sensation of food being stuck, coughing, choking, or even drooling. Do not ignore these symptoms, as they can lead to serious complications such as nutritional deficiency, weight loss, dehydration, or aspiration pneumonia.
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The causes of dysphagia are numerous: abnormal growths, nervous system diseases, gastroesophageal reflux, eosinophilic esophagitis, stroke, dementia, or aging. Each cause requires a specific diagnostic and therapeutic approach.
Regarding neurodegenerative diseases, Parkinson’s disease can induce difficulties during the oral and pharyngeal phases of swallowing, an abnormality in chewing, and altered tongue movements. Amyotrophic lateral sclerosis, on the other hand, manifests as poor oral transport and problems maintaining the bolus in place. These disorders can jeopardize life expectancy, particularly due to the high risk of silent aspiration.
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The phenomenon of ‘aspiration’ is a specific swallowing disorder where food or liquid enters the airways. It is a serious event that manifests as coughing during or after swallowing, and a choking sensation. In some cases, it can trigger a gag reflex. Quick identification and appropriate management of aspiration are crucial to prevent respiratory complications, such as aspiration pneumonia.
Management of swallowing disorders: treatments and practical advice
Diagnosis and treatment: The management of dysphagia begins with an accurate diagnosis, often involving examinations such as a barium swallow, dynamic swallowing study, endoscopy, or fiberoptic endoscopic evaluation. Depending on the etiology, treatment may include medications, dietary modifications, and swallowing exercises. For specific disorders, dilation or surgery may be necessary. Dietary modifications recommend a preference for soft foods and modified textures, while it is important to avoid dry or coarse foods, tough meats, as well as nuts and seeds, not to mention raw fruits and vegetables.
Specialized techniques and dietary behavior adaptation: VitalStim® Therapy, a non-invasive therapy, uses electrical stimulation to activate the swallowing muscles and has shown the ability to improve swallowing function over a sustained period of three years. Dietary behavior adaptation also includes strategies for managing aspiration, such as adopting an upright posture with the head tilted down during meals, favoring hot dishes and cold or sparkling drinks. In the event of aspiration, it is advised, depending on the situation, not to slap the back and to ask the person to cough, or to apply back blows and the Heimlich maneuver for more severe cases.
Prevention and aging-related management: Managing swallowing disorders related to aging relies on a diet rich in fiber, vitamin D, and calcium. Regular physical activity, at least two and a half hours per week, helps maintain muscle tone, including that of the muscles involved in swallowing. Sleep, with 7 to 8 hours per night, and stress management through exercises and breathing techniques, also play a crucial role in preserving quality of life and minimizing risks associated with swallowing disorders.