Difficulty swallowing, medically known as dysphagia, is a condition that can significantly affect an individual’s ability to eat, drink, and maintain proper nutrition. Oropharyngeal dysphagia is a specific type of swallowing difficulty originating in the mouth and throat.
What is Oropharyngeal Dysphagia
Oropharyngeal dysphagia involves problems during the initial phases of swallowing: the oral and pharyngeal stages. The oral phase begins with preparing food in the mouth, involving chewing and mixing it with saliva to form a manageable bolus. This bolus is then moved to the back of the throat by the tongue.
Following the oral phase, the pharyngeal phase is an involuntary reflex that propels food or liquid down the throat and into the esophagus, while protecting the airway. In oropharyngeal dysphagia, disruptions can occur in the coordination of muscles and nerves responsible for these actions. This leads to impaired movement of the food bolus from the mouth to the esophagus, including problems with soft palate elevation, movement of the larynx and hyoid bones, and relaxation of the upper esophageal sphincter.
Recognizing the Signs
Recognizing the signs of oropharyngeal dysphagia is important. Individuals may experience coughing or choking during or immediately after eating or drinking, suggesting food or liquid may be entering the airway. A frequent sensation of food sticking in the throat after swallowing is common. Drooling or spillage of food from the mouth can occur if there is difficulty controlling oral contents.
A gurgly or wet voice quality after swallowing indicates residue may be left in the throat or on the vocal cords. Recurrent chest infections, such as pneumonia, are a concern as they can result from aspiration, where food or liquids enter the lungs. Unexplained weight loss and avoiding certain food textures or liquids are also common indicators.
Underlying Causes
Oropharyngeal dysphagia can arise from medical conditions that disrupt the swallowing mechanism. Neurological conditions frequently contribute, including stroke, Parkinson’s disease, multiple sclerosis, and dementia, as these can impair nerve signals and muscle control needed for swallowing. Brain or spinal cord injuries can similarly affect swallowing ability.
Structural issues can also lead to this condition. Head and neck cancers, or treatments like radiation therapy, can cause damage or narrowing in the swallowing pathway. Strictures, abnormal narrowings, or diverticula, small pouches that can collect food particles, may also impede food passage through the throat. Muscle disorders such as myasthenia gravis, an autoimmune disease affecting nerve-muscle communication, can weaken swallowing muscles. Age-related changes, often referred to as presbyphagia, can also increase susceptibility to dysphagia due to reduced muscle mass, decreased tissue elasticity, and changes in oral and pharyngeal sensitivity.
How it’s Diagnosed
Diagnosis of oropharyngeal dysphagia begins with a clinical swallowing evaluation by a speech-language pathologist (SLP). This initial assessment involves reviewing medical history, observing swallowing, and assessing oral motor function. The SLP evaluates the patient’s ability to manage different food and liquid consistencies and looks for signs like coughing or a wet voice.
Following the clinical evaluation, instrumental assessments provide a detailed understanding of the swallowing process. The Videofluoroscopic Swallowing Study (VFSS), also known as a modified barium swallow, is an X-ray procedure where the patient swallows barium-coated foods and liquids. This allows real-time visualization of bolus movement through the mouth and throat, identifying issues like premature spillage, pharyngeal residue, or aspiration.
Another instrumental assessment is the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). This involves passing a flexible endoscope through the nose to visualize pharyngeal and laryngeal structures during swallowing. FEES assesses airway protection, secretion management, and the effectiveness of compensatory strategies, providing insights into the swallowing impairment.
Treatment and Management
Managing oropharyngeal dysphagia involves strategies to improve swallowing safety and efficiency. Compensatory strategies involve modifying food and liquid textures to make them easier to swallow. This includes thickening liquids or pureeing solid foods, and using specific swallowing postures like a chin tuck or head turn to redirect food flow. Taking smaller bites and sips, and allowing more time between swallows, also helps manage intake safely.
Rehabilitative exercises strengthen swallowing muscles and improve coordination. These exercises target the tongue, lips, jaw, and pharyngeal muscles through range-of-motion and strengthening tasks. Examples include the Mendelsohn maneuver, which prolongs upper esophageal sphincter opening, or the Shaker exercise, which strengthens suprahyoid muscles.
For underlying medical conditions, medical or surgical interventions may be necessary. This includes medications for reflux, dilating strictures to widen the swallowing pathway, or surgically removing obstructions like tumors or diverticula. A multidisciplinary team, including doctors, speech-language pathologists, and dietitians, collaborates to create a comprehensive treatment plan. This ensures adequate nutrition and prevents complications like aspiration pneumonia.