Diagnosis and Treatment of Dysphagia:
A Comprehensive Guide
Diagnosis
Dysphagia is diagnosed by speech pathologists however is often noted by other medical professionals who refer to speech pathologists for assessment. Other healthcare professionals might include nurses, physiotherapists, occupational therapists, dietitians and allied health assistants.
Often, dysphagia is identified by incidentally observing the symptoms of dysphagia during seemingly normal tasks throughout the day. For example, when a person coughs while drinking water, has trouble chewing or swallowing their food, or difficulty taking tablets.
Typically, the diagnostic process involves assessing the nerves and muscles of the face and neck, and eating and drinking in front of a speech pathologist. However, there are more thorough avenues to assess the swallow such as a videofluoroscopy- an x-ray video of the swallow, or FEES- a flexible tube with a camera that goes up the nose and down the throat to observe the swallow from a bird’s eye view. However, it’s important to note that these are not always necessary or appropriate for each person and they are only deemed so by the treating speech pathologist or medical professional.
Being a secondary condition, dysphagia is caused by a primary or overarching condition that causes the difficulty swallowing. There are numerous conditions that can cause or contribute to dysphagia, see associated conditions for more on this.
Sometimes, a primary diagnosis is not yet known and the multidisciplinary team works together to assess the symptoms occurring throughout the person’s whole body to identify the cause. Doctors and specialists often use this information along with other medical testing to assist with the diagnostic process.
Treatment
Treatments for dysphagia varies depending on the individual but most often symptoms are managed with a modified diet and thickened fluids. There are international standards for these known as "IDDSI" that often reduce or eliminate symptoms of dysphagia and the risk of choking. They range from Level 0- normal fluids, to Level 7- regular foods. The scale is a continuum so that food and fluids cross over as the food becomes more modified and the drinks become thicker. There are a few additional food descriptions such as dual consistency and transitional foods that describe niche consistencies and can be found *here* in more detail.
People with dysphagia are often prescribed a range of safe swallowing strategies that can vary between generic strategies and tailored strategies that are based on the assessment of an individual’s swallow. Some safe swallowing strategies might include;
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Sit upright and be alert when eating and drinking
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Take small sips or small mouthfuls of food
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Chew food well before swallowing
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Alternate food and drink, or sip a drink after each mouthful of food
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Take extra swallows with each mouthful
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Add extra sauces and gravies for moisture, or choose moist food options
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Wash your teeth and gums regularly to keep the mouth and saliva clean
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Remain upright for 30 minutes after food and drink to avoid reflux and regurgitation
In addition to this, some people may be appropriate for dysphagia rehabilitation. This involves daily exercises of the mouth and/or neck muscles that contribute to the swallow. The regime is often established after videofluoroscopy (xray video) to identify which parts of the swallow need to be strengthened or practiced. Often, however, eating and drinking is therapy in itself and each meal is a part of rehabilitation. There are also other factors to decide whether someone would benefit from rehabilitation or not as not all people are good candidates for such treatment. However, that is best left to the expertise of your treating speech pathologist.
Occasionally, there are other medical options and considerations involved in dysphagia rehabilitation and treatment. Some other health professionals that may be involved to help manage dysphagia include;
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Radiologists
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Ear Nose and Throat (ENT) specialists
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Gastroenterologists