Dysphagia
dys·pha·gia /dɪsˈfeɪ dʒə, -dʒi ə/
–noun Pathology.
difficulty in swallowing.


“Dysphagia is not a primary medical diagnosis but rather a symptom of underlying disease and therefore described most often by its clinical characteristics (signs)” (Groher & Crary, 2010, p. 2; Horner et al., 1994). Dysphagia can occur at any stage of deglutition (Schindler & Kelly, 2002).


The signs and symptoms of dysphagia are many – and they can vary greatly from one person to the next (Griffin et al., 2009).

Possible signs and symptoms of dysphagia (from Kayser-Jones & Pengilly, 1999):
· complaints by patient or carers that swallowing seems difficult
· unexplained weight loss
· refusal of food or liquid, or resistance to being fed quickly
· recurrent chest infections, respiratory infections, and/or aspiration pneumonia
· change in voice quality (e.g., wet, gurgling or horse voice)
· coughing pre, during or post-swallow with intake of liquids or food
· inability to control saliva or food in the oral cavity (e.g., drooling, food leakage from the mouth)
· increased congestion or saliva post meal
· retention of food or liquid in the oral cavity or pharynx

· aspiration


The following are typical characteristics/indicators of dysfunction for each of the stages of deglutition:
Pre-oral phase dysfunction: This phase is greatly affected when individuals are dependent on others for (Leopold & Kagel, 1997). Factors influencing include the milieu of the meal (visual and olfactory characteristics of the food, emotional state or level of arousal, ambiance), state of hunger (or time of feeding) and motor skills (ability to self feed).
Oral preparatory phase dysphagia: It is overt and observable (Cichero, 2006) – often indicated by an inability to control saliva or food/liquid in the oral cavity (e.g., drooling, food leakage from the mouth). Unobservable without instrumental assessment is the inability to retain material within the oral cavity resulting in premature spillage (Kayser-Jones & Pengilly, 1999).
Oral phase dysphagia: It is often characterised by an inability to move the bolus anteriorly-posteriorly.
Pharyngeal phase dysphagia (see below images): Individuals may complain of having the sensation of food stuck in their throat or of nasal regurgitation of food or liquid (Groher & Crary, 2010). The term for the feeling of something stuck in the throat is global sensation (Groher & Crary, 2010). Dysfunction at this stage may also result in the individual coughing post-swallow (due to aspiration ). Silent aspiration may also occur.

pharyngeal_phase_dysphagia.jpg

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