Having a hard time swallowing, also known as dysphagia, can happen with some neurological conditions including:

• Stroke
• Traumatic brain injury (TBI)
• Cerebral palsy
• Parkinson's disease

• Multiple sclerosis
• Progressive supranuclear palsy
• Huntington's disease
• Myasthenia gravis

There are two main symptoms of swallowing disorders. Some people are not able to swallow any food or drinks. Others may cough or choke on things they swallow when it goes down the wrong part of their throat. When someone chokes on their food or drink it puts them at risk for aspiration. Aspiration is when food or drinks go down the windpipe into the lungs. This can be very dangerous and lead to pneumonia, an illness that affects the lungs.

People who have difficulty swallowing may have food that gets “stuck” when they swallow and may start drooling. They drool because they have a hard time swallowing the saliva in their mouth.

Treatment includes adding thickeners to food and drinks or changing how the individual eats or chews. Medication may make it easier for some people to swallow. For more severe cases, people may need surgery or a feeding tube.

People with dysphagia have difficulty swallowing and may even experience pain while swallowing (odynophagia). Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body and can lead to additional serious medical problems.

The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat (see figure). During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs.

The third stage begins when food or liquid enters the esophagus, the tube that carries food and liquid to the stomach. The passage through the esophagus, called the esophageal phase, usually occurs in about three seconds, depending on the texture or consistency of the food, but can take slightly longer in some cases, such as when swallowing a pill.

Dysphagia has many possible causes and happens most frequently in older adults. Any condition that weakens or damages the muscles and nerves used for swallowing may cause dysphagia. For example, people with diseases of the nervous system, such as cerebral palsy or Parkinson’s disease, often have problems swallowing. Additionally, stroke or head injury may weaken or affect the coordination of the swallowing muscles or limit sensation in the mouth and throat.

People born with abnormalities of the swallowing mechanism may not be able to swallow normally. Infants who are born with an opening in the roof of the mouth (cleft palate) are unable to suck properly, which complicates nursing and drinking from a regular baby bottle.

In addition, cancer of the head, neck, or esophagus may cause swallowing problems. Sometimes the treatment for these types of cancers can cause dysphagia. Injuries of the head, neck, and chest may also create swallowing problems. An infection or irritation can cause narrowing of the esophagus. Finally, for people with dementia, memory loss and cognitive decline may make it difficult to chew and swallow.

Dysphagia occurs when there is a problem with the neural control or the structures involved in any part of the swallowing process. Weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing. A stroke or other nervous system disorder may make it difficult to start the swallowing response, a stimulus that allows food and liquids to move safely through the throat. Another difficulty can occur when weak throat muscles, such as after cancer surgery, cannot move all of the food toward the stomach. Dysphagia may also result from disorders of the esophagus.

If you have a sudden or gradual change in your ability to swallow, you should consult with your physician. He or she may refer you to an otolaryngologist—a doctor who specializes in diseases of the ear, nose, throat, head, and neck—and a speech-language pathologist. You may be referred to a neurologist if a stroke or other neurologic disorder is the cause of the swallowing problem.

There are different treatments for various types of dysphagia. Medical doctors and speech-language pathologists who evaluate and treat swallowing disorders use a variety of tests that allow them to look at the stages of the swallowing process. One test, the Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), uses a lighted fiberoptic tube, or endoscope, to view the mouth and throat while examining how the swallowing mechanism responds to such stimuli as a puff of air, food, or liquids.

A videofluoroscopic swallow study (VFSS) is a test in which a clinician takes a videotaped X-ray of the entire swallowing process by having you consume several foods or liquids along with the mineral barium to improve visibility of the digestive tract. Such images help identify where in the swallowing process you are experiencing problems. Speech-language pathologists use this method to explore what changes can be made to offer a safe strategy when swallowing. The changes may be in food texture, size, head and neck posture, or behavioral maneuvers, such as “chin tuck,” a strategy in which you tuck your chin so that food and other substances do not enter the trachea when swallowing. If you are unable to swallow safely despite rehabilitation strategies, then medical or surgical intervention may be necessary for the short-term as you recover. In progressive conditions such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), a feeding tube in the stomach may be necessary for the long-term.

For some people, treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat in a special way. For example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help in some situations. For instance, people who cannot swallow thin liquids may need to add special thickeners to their drinks. Other people may have to avoid hot or cold foods or drinks.

For some, however, consuming enough foods and liquids by mouth may no longer be possible. These individuals must use other methods to nourish their bodies. Usually this involves a feeding system, such as a feeding tube, that bypasses or supplements the part of the swallowing mechanism that is not working normally.

Dysphagia can be serious. Someone who cannot swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight.

Food pieces that are too large for swallowing may enter the throat and block the passage of air. In addition, when foods or liquids enter the airway of someone who has dysphagia, coughing or throat clearing sometimes cannot remove it. Food or liquid that stays in the airway may enter the lungs and allow harmful bacteria to grow, resulting in a lung infection called aspiration pneumonia.

Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. While lying down or sleeping, someone with this problem may draw undigested food into the throat. The esophagus may also be too narrow, causing food to stick. This food may prevent other food or even liquids from entering the stomach.

You may have trouble swallowing due to loss of control of your mouth and throat muscles. As a result, chewing and managing solid foods can be difficult. If you have difficulty chewing or swallowing, there are several things you can do to make eating and drinking easier and safer.

1) Choose soft moist foods such as:

• Scrambled eggs
• Macaroni and cheese
• Soups and stews
• Ice cream, custard and puddings
• Mashed potatoes with gravy
• Cooked cereal without lumps
• Yogurt or gelatin made with soft canned fruit
• Cooked vegetables
• Cottage cheese

2) Chop, puree or blenderize foods you have difficulty chewing or swallowing.

3) Add gravy, sauces, broth, butter, margarine, mayonnaise or sour cream to soften and moisten foods.

4) Cut food into small bites.

5) Soften hard foods such as toast by dunking it into milk, cocoa, coffee or tea.

6) Keep mealtime relaxed.

7) Sit as upright as possible when you eat.

8) Do not talk and swallow at the same time.

9) Take small bites, less than 1 teaspoon per bite of food. Chew well and swallow your food before taking another bite.

10) Take a sip of beverage after each bite of food.

11) Do not try to wash down solids with sips of liquids, unless your speech or swallowing therapist instructs you to do so.

12) Drink 8 cups of fluid each day, unless you are on a fluid restriction or you have difficulty swallowing water or other thin liquids. If you require thickened liquids, follow recommendations for the appropriate thickness.

13) Contact your healthcare provider, dietitian or speech pathologist if your swallowing worsens, you cough when eating or drinking solids and/or liquids or losing weight.

Scientists are conducting research that will improve the ability of physicians and speech-language pathologists to evaluate and treat swallowing disorders. Every aspect of the swallowing process is being studied in people of all ages, including those who do not have dysphagia, to give researchers a better understanding of how normal and disordered processes compare.

Research has also led to new, safe ways to study tongue and throat movements during the swallowing process. These methods will help physicians and speech-language pathologists safely evaluate a patient’s progress during treatment.

Studies of treatment methods are helping scientists discover why some forms of treatment work with some people and not with others. This knowledge will help some people avoid serious lung infections and help others avoid tube feedings.