The odd swallowing mishap from time to time is generally nothing to worry about. It may happen when you talk or laugh while eating and drinking, or when you try to push down too-large bites because you’re rushing through your meal.
But if a swallowing issue occurs with some sort of regularity or pattern, this raises concerns, said Deborah Ross, a speech-language pathologist and CEO of San Diego Speech Therapy. There might be some damage or weakening of the muscles or nerves involved in the swallowing process.
Left unmanaged, difficulty swallowing (also known as dysphagia) can lead to airway blockage, malnutrition, dehydration and recurrent chest infections. You may be at higher risk of aspiration pneumonia, where you develop an infection from food or liquid that enters your airway.
Swallowing impairment affects around 1 in 7 independent adults ages 60 and above. According to Ross, it is underrecognised and often goes undetected. Many people also don’t know the signs or how to manage it.
Swallowing impairment is commonly seen in people with progressive neurological disease (like Parkinson’s disease), dementia, stroke and head and neck cancer. Head, neck and chest injuries can also affect your swallowing.
Some people experience gradual weakening and loss of their muscles as they age, including their swallowing muscles, said Eileen Domalaog, a speech-language pathologist at Salinas Valley Speech Pathology.
Certain side effects from medications make swallowing onerous, Ross said, by drying out the mouth or affecting muscle control.
“We’re also seeing an increase with people with difficulty swallowing related to stress and anxiety,” she said.
Sometimes, it might not have anything to do with your swallowing muscles, but rather with your teeth. Dentures that aren’t fitting well, wobbly teeth or missing teeth can compromise your ability to chew your food well.
Swallowing difficulty can look like coughing when eating or drinking, feeling like food is sticking to your throat, taking more effort than usual to swallow, having to swallow multiple times to clear food from your mouth, sounding gurgley when you talk after drinking because there’s liquid caught in your throat, or feeling like something is stuck in your chest.
If there’s someone in your life who isn’t able to voice their swallowing concerns to you due to a medical condition like advanced dementia, Ross said to observe them for the following signs: They have less interest in eating, are taking a longer time to eat, are losing weight, or they contract respiratory infections more frequently.
If you have trouble swallowing on a more frequent or consistent basis, or if you notice a pattern in which it occurs, both speech pathologists emphasized the importance of letting your primary care doctor know.
An example of a pattern might be that you’re consistently having issues with swallowing the same few foods and drinks, Ross explained. You should also inform your doctor if you start to experience swallowing difficulty after a new medical diagnosis.
“It’s very strongly recommended that they have their swallowing evaluated,” Domalaog said. “If there’s a swallowing problem, that’s good to know. If it is the beginning of a swallowing problem, it’s important to tackle it early. Early intervention is the best way to go, and not to wait.”
“The best place to start is with the physician, because you’ll need a doctor’s order to get your insurance to cover your evaluation with a speech pathologist,” said Ross.
Speech pathologists are the health providers who perform in-depth swallow evaluations to assess your muscles and nerves. Based on their evaluation, they will suggest a treatment plan for you.
Worried that bringing up a swallowing issue means you’ll have to be on thickened drinks and minced food for the rest of your life?
Worry not. “We look for every option other than modifying foods and liquids in modern practice,” Ross said. The speech pathologist’s goal is to rehabilitate your swallowing ability. They are likely to work with you on different throat exercises to train your muscles.
For most people, food and drink texture modifications are only temporary, to “bridge the gap” as you “work your way back to being able to eat as normally as possible,” she said.
To be effective, swallow rehabilitation exercises need to be done under the supervision of a speech pathologist, Domalaog said. The speech pathologist will ensure that you complete them at the correct intensity and frequency.
“We’re doing them with a strong intensity, and often it goes beyond what a patient thinks they can do,” Domalaog explained.
