Related Conditions
Dysphagia can arise out of many different primary conditions which is why dysphagia can present in so many different ways. The prognosis and journey through dysphagia is often dictated by the overarching cause. Have a read below about some common primary conditions that can cause dysphagia.
Stroke
More than 50% of people who suffer fromw stroke present with some form of dysphagia afterwards. This is due to damage of the neurological pathways in the brain that control the swallow. Fortunately, most people’s dysphagia resolves in the first 5-7 days as the brain begins to heal itself. However, a small percentage of people continue to live with dysphagia for 6 months or more, if not indefinitely. Rehabilitation is often encouraged in the early months of recovery while the brain is “plastic” or healing in order to return the swallow as close to normal as possible.
Traumatic Brain Injury (TBI)
Dysphagia occurs in up to 93% of people with severe traumatic brain injury, usually as a result of a single event. Dysphagia is often a symptom in the early stages of TBI and improvement occurs in the first 3 months. A person might continue to make improvement after these early stages however in severe cases, the dysphagia may become a chronic condition and require long term management. Dysphagia is likely to look different in each individual when it is due to TBI as the nature or location of the injury varies from person to person.
Parkinson's Disease
Parkinson’s disease has a range of “typical” symptoms that a person can present with, although every individual presents in their own way and doesn’t necessarily experience all of the “typical” symptoms. However, one of the most common symptoms in the late stages of the disease is dysphagia, occurring in approximately 68% of cases. This is due to the general patterns of reduced range of movement, speed and coordination, and difficulty initiating motor movements which translates to the movement of the swallow. People living with Parkinson’s Disease are often recommended some kind of diet modification although the severity of dysphagia varies from person to person. Rehabilitation and maintenance therapy is usually available in this population however the earlier you treat the dysphagia, the better the outcome.
Dementia
There are many different kinds of dementias but given the progressive nature of all variations, as the condition progresses dysphagia becomes a common symptom in many people. This can be a combination of the changes to motor and sensory neural pathways, and various cognitive changes associated with each type of dementia. Symptoms of dysphagia vary but can include; prolonged chewing, holding the food or drink in one’s mouth or coughing with food and drink. Rehabilitation is less common in these populations due to the late onset of dysphagia when cognition and sometimes behavioural changes occur and become a barrier to therapy. This leaves modified food and drinks as the primary form of intervention in this population.
Motor Neuron Disease (MND)
Motor Neurone Disease (MND) mostly affects the neurons found in the skeletal muscles. Subsequently, MND can affect the swallowing muscles and result in dysphagia. Up to 80% of people with MND present with dysphagia, being particularly notable for people with bulbar onset; a subtype of MND. A weak cough is also a notable symptom of MND which means that airway protection is further compromised as expelling food and drink from the airway becomes more difficult and less effective.
Rehabilitation is not common in this population due to fatigue effects of the disease so modified diets and fluids are typically used to manage symptoms. However, in later stages of MND, enteral feeding or feeding tubes may be used to support nutrition as the severity of dysphagia symptoms increase.
Multiple Sclerosis (MS)
Multiple Sclerosis (MS) is another neurological condition that affects the nerves throughout the body. There is more than one type of MS including relapsing remitting which can be described as “episodes” or “attacks.” Approximately 45% of people with MS present with dysphagia which typically increases during an “attack.” Treatment can be helpful in the recovery however a general decline in function is often evident over time. Typically, MS is a slowly progressing condition so the severity of dysphagia can be different across early, middle and advanced stages of the condition however is often managed with modified diets and fluids.
Head and Neck Cancer
Head and Neck Cancer is the seventh most common cancer in the world and dysphagia is one of the most common symptoms and/or side effects to the condition. Dysphagia presents differently in each person because the symptoms are dependent on the cancer location, stage and treatment. Dysphagia can be caused by surgical intervention where malignant anatomy is removed and therefore parts of the mouth, tongue or throat are missing. Even if they are reconstructed they usually can no longer effectively contribute to the swallowing process. Dysphagia can fluctuate through interventions such as radiotherapy and chemotherapy however often improves when treatment is complete. However, side effects to such interventions including xerostomia (dry mouth) and sensory or taste changes can further impact dysphagia if they persist in the long term. There are long term effects of radiation exposure that impact the structures targeted during treatment which result in dysphagia years afterwards. However, again, the pattern of onset and progression will be dependent on the individual. Rehabilitation is recommended and common in head and neck cancer where it is deemed appropriate by speech pathologists, especially to preserve function in the case of long term radiation effects. More often than not though, dysphagia symptoms must be managed using modified diets and fluids.
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease that causes restricted airflow to the lungs and difficulty breathing. The prevalence of dysphagia is unknown in people with COPD however it is a common symptom of the condition related to the breath-swallow coordination and the pressure systems involved in the swallow. Symptoms often look like sticking of food and drink in the throat and coughing or throat clearing when eating and drinking. This often becomes worse if shortness of breath increases throughout a meal. There are strategies to help reduce the severity of symptoms and respiratory related rehabilitation that inadvertently improves the swallow. However, in chronic or more advanced conditions, modified diets and fluids are used to manage dysphagia.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GORD/GERD) or simply, acid reflux, is another unknowingly common cause of dysphagia. It is the most common gastrointestinal condition in Australia with approximately 10-15% of the population experiencing the condition. Sometimes, reflux can be silent which means that a person does not present with any symptoms and therefore does not seek treatment for it, even though it may still be causing damage or injury to the oesophagus and/or throat.
GORD can cause dysphagia as chronic exposure to acid reflux can result in changes to the muscle contractions of the throat. It can also result in changes to sensation with a common symptom including “globus”- the feeling of something being stuck in your throat, even when nothing is there or without eating and drinking anything.
In these cases, assessment and treatment is usually a combined effort between the speech pathologist and medical professional for both diet or fluid modifications and reflux management using medications.