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Trouble Swallowing? Let's talk about dysphagia!



What is dysphagia?

Dysphagia is the medical term for “difficulty swallowing.” 1 in 25 adults experience difficulty swallowing every year (Bhattacharyya, 2014). Dysphagia can occur following multiple diagnoses including stroke, Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS), critical illness (both requiring intubation and not), dementia, gastroesophageal reflux (GERD), head and neck cancer (HNC), traumatic brain injury (TBI), multiple sclerosis (MS), and more!


How does a speech language pathologist (SLP) fit into dysphagia?

A speech language pathologist (SLP) is a healthcare professional who evaluates and treats many disorders including dysphagia. At Coastal Plain Therapy & Wellness, our SLPs who have received extensive education and training in the prevention, diagnosis, and treatment of dysphagia and related conditions.


Who is at risk for dysphagia related complications?

The following symptoms may indicate that you or a loved one may benefit from an evaluation by a speech language pathologist with experience assessing and treating swallowing disorders:

  • Difficulty initiating a swallow

  • Drooling and poor secretion management

  • Food or liquid remaining in the mouth after the swallow (oral residue)

  • Difficulty maintaining lip closure (anterior loss of bolus)

  • Food and/or liquid leaking from the nasal cavity

  • Coughing or choking during meals

  • Pain or discomfort while swallowing

  • Feeling something “stuck” in the throat (globus sensation)

  • Feeling food or liquid “coming back up” after meals (GERD)

  • Difficulty swallowing pills

  • Sudden decrease in appetite

  • Repeated diagnoses of pneumonia

  • Shortness of breath during or after meals

  • Weight loss, malnutrition, dehydration

What is included in a swallowing evaluation?

Your speech language pathologist will take a detailed medical and nutritional history to determine your risk factors and/or causes for dysphagia. Several medications may contribute to difficulty swallowing and coughing, so we want to be sure that we are diligent and thorough! Next, a perceptual assessment will be used to determine a standardized measurement of the patient's perception of his/her symptoms (e.g., How is this impacting your quality of life?). A standardized screening protocol will then be administered such as the Yale Swallow Protocol (Suiter et al., 2014). A full cranial nerve examination will be administered along with an assessment of the patient's overall structure and function of the oral mechanism (e.g., face, lips, tongue, jaw, palate, oropharynx, and oral mucosa.


Following a full assessment, the speech language pathologist will be able to provide a detailed description of signs/symptoms and diagnosis. Recommendations for further treatment or referrals are provided at the end of the session. If the patient has suspected oropharyngeal dysphagia, an instrumental examination may be indicated. An instrumental examination provides the imaging necessary for SLPs to provide targeted, evidence-based intervention to improve swallow function and efficiency.

There are two types of instrumental swallowing evaluations that are recommended by SLPs. Modified barium swallow studies (MBSS) are completed in the hospital setting with a radiologist and speech language pathologist present. Fiberoptic endoscopic evaluation of swallowing (FEES) are completed across multiple settings (hospitals, outpatient clinics, skilled nursing facilities, ENT offices, etc.).


Fiberoptic Endoscopic Evaluation of Swallowing (FEES)


A clinical bedside evaluation alone cannot accurately detect or diagnose oropharyngeal dysphagia. Imaging is required for an accurate diagnosis and prognosis. FEES is a cost-effective and convenient alternative to modified barium swallowing studies (MBSS) that are performed in hospitals. An endoscopic evaluation provides the imaging necessary to diagnose dysphagia, and develop patient-centered treatment plans to improve outcomes. No radiation exposure is required and no barium is used during the examination.


Coastal Plain Therapy & Wellness is a proud to be a comprehensive swallowing center and FEES provider! Contact us today to schedule an evaluation or to talk more about our mobile FEES program for skilled nursing facilities.

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