Dysphagia FAQ

 

What are feeding and swallowing disorders?

Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder. Swallowing disorders , also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:

  • Oral phase- sucking, chewing, and moving food or liquid into the throat
  • Pharyngeal phase- starting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway ( aspiration ) or to prevent choking
  • Esophageal phase- relaxing and tightening the openings at the top and bottom of the feeding tube in the throat ( esophagus ) and squeezing food through the esophagus into the stomach

What are some signs or symptoms of feeding and swallowing disorders in children?

Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child. The following are signs and symptoms of feeding and swallowing problems in very young children:

  • arching or stiffening of the body during feeding
  • irritability or lack of alertness during feeding
  • refusing food or liquid
  • failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
  • long feeding times (e.g., more than 30 minutes)
  • difficulty chewing
  • difficulty breast feeding
  • coughing or gagging during meals
  • excessive drooling or food/liquid coming out of the mouth or nose
  • difficulty coordinating breathing with eating and drinking
  • increased stuffiness during meals
  • gurgly, hoarse, or breathy voice quality
  • frequent spitting up or vomiting
  • recurring pneumonia or respiratory infections
  • less than normal weight gain or growth

As a result, children may be at risk for:

  • dehydration or poor nutrition
  • aspiration (food or liquid entering the airway) or penetration
  • pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
  • embarrassment or isolation in social situations involving eating

What are some signs or symptoms of swallowing disorders?

Several diseases, conditions, or surgical interventions can result in swallowing problems. General signs may include:

  • coughing during or right after eating or drinking
  • wet or gurgly sounding voice during or after eating or drinking
  • extra effort or time needed to chew or swallow
  • food or liquid leaking from the mouth or getting stuck in the mouth
  • recurring pneumonia or chest congestion after eating
  • weight loss or dehydration from not being able to eat enough

As a result, adults may have:

  • poor nutrition or dehydration
  • risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
  • less enjoyment of eating or drinking
  • embarrassment or isolation in social situations involving eating

What causes swallowing disorders in adults?

Some causes of feeding and swallowing problems in adults are: Damage to the nervous system, such as:

  • stroke
  • brain injury
  • spinal cord injury
  • Parkinson’s disease
  • multiple sclerosis
  • amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
  • muscular dystrophy
  • cerebral palsy
  • Alzheimer’s disease

Problems affecting the head and neck, including:

  • cancer in the mouth, throat, or esophagus
  • injury or surgery involving the head and neck
  • decayed or missing teeth, or poorly fitting dentures

Communication Facts: Special Populations: Dysphagia – 2008 Edition

Swallowing is one of the most complex neuromuscular interactions in the human body. Swallowing problems (dysphagia) may be classified as oropharyngeal or esophageal. Oropharyngeal dysphagia refers to difficulty in the passage from the mouth to the esophagus. In esophageal dysphagia, there is a disordered passage of food through the esophagus (1). These problems should be distinguished from feeding disorders, which are difficulties in presenting food to the mouth (2). Swallowing problems are related to neuromotor speech disorders in that they frequently (though not necessarily always) accompany disturbances in speech movement.

General Demographics

  • The exact prevalence of dysphagia is unknown. Epidemiologic studies, however, indicate that the prevalence may be as high as 22% in those over 50 years of age (1).
  • Approximately 10 million Americans are evaluated each year with swallowing difficulties (2).
  • Swallowing difficulties negatively impact quality of life functioning (4). Impaired swallowing can cause significant morbidity and mortality (5).

Disorders Causing Dysphagia

Neurogenic Dysphagia

  • Neurologic disorders include stroke, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis. These disorders may produce oropharyngeal dysphagia (1). It is found in both pediatric and adult populations (2, 6, 7).
  • Several studies conclude that between 300,000 and 600,000 individuals in the United States are affected by neurogenic dysphagia each year (6, 8).

Stroke

  • Studies on the prevalence of dysphagia range from 25%-70% in patients who have experienced stroke. These estimates vary because of the method of assessing swallowing function, the timing of swallowing assessment after stroke, and the number of and type of stroke patients studied (1, 6, 9-12).
  • There is a consistently high incidence of dysphagia and pneumonia in patients with stroke (12).
  • Although dysphagia improves in most patients following a stroke, in many of them the swallowing difficulties follow a fluctuating course, with 10%-30% of individuals continuing to have dysphagia with aspiration (6).
  • Dysphagia, and speech and language disturbances are common consequences of the high incidence of stroke (10, 11).

Traumatic Brain Injury

Established incidence figures for dysphagia in individuals with traumatic brain injury vary greatly depending on whether the population studied is comprised of severe TBI patients, consecutive brain injury admissions, acute TBI patients, or patients in the rehabilitation phase of recovery (13).

Huntington’s Disease

  • Although dysphagia is not an obvious symptom of Huntington’s disease, it is a common symptom that may be associated with fatal complications (14).
  • Dysphagia hinders nutritional intake and places the patient at risk for aspiration (15).

Multiple Sclerosis

  • Patients with multiple sclerosis (particularly those with brainstem involvement) are reported to have swallowing difficulties. Dysphagia may develop early or late in the disease’s process. Among the difficulties are choking and a “sticking” of food in the throat (16, 17).
  • There is a high prevalence of clinical symptoms of oropharyngeal dysphagia in patients with multiple sclerosis (18).
  • Over 30% of individuals with multiple sclerosis experience swallowing problems, a higher rate than previously assumed (19).

Parkinson’s Disease

  • Patients with Parkinson’s disease not only experience dysfunction of the various phases of swallowing, but they also have great difficulty in their ability to feed themselves (20).
  • Dysphagia is a symptom reported by 20%-40% of patients with idiopathic (i.e., of unknown cause) Parkinson’s disease (21).

Amyotrophic Lateral Sclerosis (ALS)

  • Oropharyngeal dysphagia is highly prevalent in individuals with ALS (22).
  • Individuals with ALS usually die of respiratory complications within five years of diagnosis. Patients may benefit from swallowing therapy early on in the course of the disease (2).

Cerebral Palsy

  • Swallowing and sucking problems are commonly encountered within the first 12 months of life (23).
  • Most cerebral palsy patients have visible drooling (24).

Psychogenic Dysphagia

Psychogenic dysphagia is characterized by oral apraxia, but with intact speech, pharyngeal, and neurologic function. These patients undergo a detailed neurologic evaluation to rule out other forms of neurogenic dysphagia. Clinical symptoms in patients with psychogenic dysphagia may include anxiety, depression, and hypochondriasis (2).

Obstructive Lesions and Dysphagia

Dysphagia is one of the most frequent syndromes in patients with tumors of the head and neck, and esophagus (25).

Tumors

  • Tumors that affect swallowing are usually located in the skull base or brainstem. The degree of dysphagia and treatment depend on the size and type of tumor (2).
  • Depending on their location, benign or malignant tumors may cause oral or pharyngeal dysphagia (26).

Age and Dysphagia in the elderly

  • Dysphagia prevalence increases with age and poses particular problems in the older patients, potentially compromising nutritional status, increasing the risk of aspiration pneumonia and undermining the quality of life (27, 28).
  • Approximately 7%-10% of adults older than 50 years have dysphagia, although this number may be artificially low because many patients with this problem may never seek medical care (29). Of those over age 60, approximately 14% of individuals are affected by dysphagia (30).
  • The consequences of dysphagia include dehydration, starvation, aspiration pneumonia, and airway obstruction (5).

Dysphagia in children

  • Gastroesophageal reflux is common in children and is associated with morbidity rates that justify increasing interest in early diagnosis and appropriate medical or surgical treatment. In children, ENT manifestations of GERD mainly affect the larynx, ears, nose, paranasal sinuses and oral cavity. Main manifestations are laryngotracheal stenosis, laryngomalacia, otitis media with effusion, and rhinosinusitis (31).
  • Aspiration can be a problem in newborn infants, especially those born prematurely with the inability to coordinate their suck, swallow, and breathing. By 34 weeks of gestational age, however, most infants are able to perform these functions to begin bottle-feeding or breast-feeding (32).
  • When the process of sucking falters, children may develop gagging, regurgitating, or choking during feeding and may fail to thrive. Neurologically impaired children are at high risk for aspiration because of a lack of maturation of neuromuscular coordination of the oral and pharyngeal muscles, which is complicated by the increased prevalence of gastroesophageal reflux in this group (32).
  • Gastroesophageal reflux occurs frequently in infants and children and is complicated as a trigger for reactive airways disease (33).
  • Data are unavailable on the prevalence of dysphagia in the pediatric population after traumatic brain injury, despite the knowledge that recovery can be severely compromised by a swallowing impairment (13).

Setting

  • The literature varies greatly concerning the incidence and prevalence of dysphagia in different health care settings. Several studies report that dysphagia is present in:
    • 61% of adults admitted to acute trauma centers (13)
    • 41% of individuals admitted to rehab settings (13)
    • 30%-75% of patients in nursing homes (1, 2, 29, 34)
    • 25%-30% of patients admitted to hospitals (29, 35)
  • One study estimates that 10% of deaths within 30 days of admission among hospitalized patients with stroke are attributable to pneumonia, and that one death could be averted for every 11 patients in whom stroke-related pneumonia is prevented (36).

How long is a Guardian Therapy Session?

Typically Guardian therapy sessions last about 30 minutes.

Does Guardian Therapy hurt?

No. Guardian therapy is painless and non-invasive

Is Guardian Therapy Safe?

Yes. Guardian therapy has been cleared by the FDA for muscle re-education

What are the known side effects from treatment?

There are NO known side effects of treatment, however in 1% of the population there is a possibility for minor skin irritation. For this very reason Guardian has developed a proprietary hydrogel for patients with sensitive skin.

Will my insurance cover therapy?

Medicare does provide a billing code for the treatment of dysphagia as long as it is medically necessary and performed by a professional.

Is the Guardian product Latex Free?

Yes

What if I have a pacemaker?

You should consult your physician prior to treatment.