When a simple swallow endangers a person’s life

Everyone has had some experience of food or liquid “going down the wrong way.” Maybe you’ve felt strangled after gulping down a too-large bite of cornbread, or coughed while drinking too quickly. These experiences are always unpleasant, and there’s a good reason for that: whenever food or liquid goes down the wrong way, it’s starting to go into your trachea (windpipe), which leads to your lungs. Fortunately, healthy bodies are very effective at ejecting this material from the airway by coughing or throat clearing. It’s normal to get choked or cough once in a while when you’re eating or drinking, and in general the odd coughing fit here or there is nothing to worry about. However, if you or a loved one is coughing or choking on food or liquid on a regular basis, this may be a sign of a serious health problem called dysphagia.

“Dysphagia” means difficulty swallowing. Although swallowing is something that we do without thinking, it is actually a very complex process. Approximately 50 pairs of nerves and muscles need to work together to produce the smooth, well-timed movement that transports food safely from your mouth to your stomach. If the timing or coordination is not just right, serious problems can occur. Food can get caught in your airway and cause you to choke, or it can fall all the way down into your lungs. Having food or liquid fall into the lungs is called aspiration. This is a very dangerous condition that can cause potentially deadly pneumonia, as food sitting in the lungs encourages bacteria to grow and multiply.

Dysphagia can be caused by a wide variety of diseases and disorders, from stroke and head/neck cancer to heart disease and respiratory problems. Even the general muscle weakening that comes with the natural aging process can cause dysphagia. In fact, studies have found that 40 to 60% of nursing home residents have dysphagia. Because dysphagia can have potentially life-threatening consequences, it is important to be aware of the signs and symptoms of dysphagia, especially in elderly individuals who are at the highest risk of developing aspiration pneumonia.

The most noticeable signs of dysphagia are choking and coughing with food or liquid. As mentioned earlier, everyone coughs or chokes once in a while, and having a coughing fit here or there is normal. However, coughing or choking at every (or nearly every) meal is not normal and is a sign that the swallow may not be working safely. Frequent throat clearing while eating and drinking can also be a sign of dysphagia. Of course, many people cough or clear their throat frequently for reasons other than food or liquid going into their airway (e.g., sinus drainage, smoking, chronic respiratory problems). If you notice that you or a loved one frequently coughs or clears their throat during meals, try observing what happens when they are not eating or drinking. If the cough/throat clear seems to go away between meals and reappear when it’s time to eat or drink, you have reason to be concerned. Other less obvious signs of an unsafe swallow include wet-sounding breathing or vocal quality while eating or drinking. If someone’s breathing or voice suddenly becomes wet and congested-sounding when eating/drinking, this is a sign that material has entered the airway. Because these symptoms make eating and drinking embarrassing and uncomfortable, sometimes people with dysphagia avoid eating with others—or stop eating altogether.

In some people, aspiration can occur without any observable symptoms. When this happens, certain patterns of health problems can indicate that dysphagia is contributing to a person’s illness. Recurrent pneumonia, unexplained fevers, and unexplained rapid weight loss can all be caused by aspiration. Aspiration pneumonia is a secondary infection, which means that it is an infection that appears when the body is already weakened by some other factor. If someone suddenly develops pneumonia after a heart attack, fall, or major surgery, it is a good idea to look for signs of dysphagia, as food or drink entering the lungs could be the source of the pneumonia.

So what should you do if you notice some of these signs and symptoms in yourself or someone you know? It’s best to start by informing your doctor about your concerns. Your doctor will determine whether your symptoms are likely to be caused by dysphagia, or if there is some other factor that better explains them. If your doctor decides that you may have a swallowing problem, he or she will refer you to a speech therapist, who will then evaluate your swallow and make recommendations for treatment. Dysphagia is a serious disorder, but there is treatment available. Recovery from dysphagia is a highly individual process and every person experiences it differently. But for all people with dysphagia, the first step toward recovery is noticing that there is a problem and taking action to address it.

Reprinted with permission of the Kingsport Times-News – February 2012

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Children born with cleft lip or palate need ongoing care

The staff at Mountain Region Speech and Hearing Center would like to take this time to provide some general information about children born with a cleft lip/palate. According to the Center for Disease Control and Prevention, approximately 2,651 babies are born with a cleft palate and approximately 4,437 babies are born with a cleft lip (with or without cleft palate) a year in the United States. With the advances in technology, some clefts of the lip and even palate are now being seen during ultrasounds. This allows parents time to understand and educate themselves prior to the birth of their infant.

The term orofacial cleft is used to categorize all clefts of the face; cleft lips, palates, and submucous clefts. An orofacial cleft forms when during the first three months of pregnancy. The lip and/or palate of the fetus do not form together. The majority of orofacial clefts can be grouped into the following categories: cleft lip without cleft palate, cleft palate without cleft lip, cleft lip and palate. Unilateral is used to note that the cleft occurs on the left or right side; bilateral is used to describe a cleft that encompasses both the left and right side of the mouth.

The roof of your mouth is formed by a hard (bony) and soft (muscular) palate. A cleft of the palate is when there is an opening, or incomplete fusion, of the hard and/or soft palate. This allows the inside of the infant’s mouth to have a direct opening in their nasal cavity. Infants born with a cleft palate may initially have difficulty with feeding; this may be lead to a referral to a speech pathologist. During feeding evaluation the speech pathologist will assess the infant in a variety of feeding positions and with different types of bottles and nipples to help the infants’ with eating. The speech pathologist will analyze how the cleft palate is affecting the infant’s ability to create a negative pressure system to suck from a bottle.

Infants born with a cleft palate are at increased risk for speech sound disorders as they grow. After the infants have completed all of their surgeries to close the palate, parents should continue to monitor their development of sounds. Also, research has found that these children have higher incidences of language delay. Early evaluation and treatment for these speech and language delays is recommended.

The location and severity of a cleft lip will often determine if intervention by a speech pathologist is required. For some infants, they are able to easily feed and later easily pick up their speech sounds. For others, they may have difficulty creating a seal around the bottle, and may require different positioning or a different bottle. As they grow, it is important to monitor their development of sounds that require movement of the lips (m, p, b). If the child avoids these sounds or does not appear comfortable with these movements, treatment by a speech pathologist is recommended. The pathologist will assist in teaching the child how to correctly use his/her lips during the sounds.

A submucous cleft results when the outer layer of skin along the roof of the mouth forms completely; however, the inner musculature that supports function of the palate does not form together. A submucous cleft may go undetected for several years or until the child begins to use sounds and communication. Often a noticeable difference in the “nasal” quality of the individual’s speech leads to further evaluation of the soft palate function. The child may sound like too much air is coming out of his/her nose when talking or like he/she constantly have a cold (not enough air coming out of his/her
nose). An evaluation by a speech pathologist and often evaluation of the soft palate movement by an ENT allows for an accurate diagnosis of a submucous cleft.

Treatment for a submucous cleft is dependent on the severity and the symptoms. After a complete evaluation, a trial period of speech therapy to target soft palate movement may be recommended before more invasive measures. A speech pathologist can work with the child to teach him/her how to incorporate soft palate movement into their speech. In some cases surgical intervention is required prior to the initiation of speech treatment.

What contributes to the incomplete closure of lip/palate continues to be researched. For some children the resulting orofacial cleft is secondary to a syndrome. A family history of orofacial clefts and environmental factors such as medications, lack of key nutrients and exposure to cigarette smoke are thought to increase the risk of orofacial clefts.

Reprinted with permission of the Kingsport Times-News – December 2011

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Early intervention vital to treat language disorders

This month raises awareness of two disorders that require the services of a speech-language pathologist so it seemed like a good time to talk about each one. May 14 is National Cornelia de Langue Awareness Day and May 9 – 15 is National Stuttering Awareness Week.

Cornelia de Lange Syndrome (also known as Brachmann- de Lange Syndrome), named after Dr. Cornelia de Lange, is a genetic disorder that affects approximately 1 in every 10,000 live births. Since this syndrome is congenital (i.e., present at birth), infants are diagnosed shortly after being born. A diagnosis is made based on medical history, physical examination and consultation with a geneticist.

Children with CdLS often have common physical appearances and similar medical conditions, including long thin eyebrows that extend above the nose, long eye lashes, an upturned nose and thin, down- turned lips. They often have low birth weights and remain shorter and weigh less (than same age peers) as they grow. Medical conditions such as microcephaly (small head size), excessive body hair (hirsutism), small or abnormal hands and feet, gastrointestinal reflux, seizures, heart defects, cleft palate, bowel abnormalities, feeding problems, breathing difficulties and hearing deficits are also present as well as delays in speech/language skills, cognitive and behavior . As with all syndromes, individuals may exhibit several or a few traits and can have mild to profound impairments.

A speech-language pathologist experienced in treating feeding difficulties is important for these small infants. We can evaluate the infant’s ability to suck, swallow, and breathe to determine if he or she is able to safely eat. Therapists can target oral strengthening exercises and increase oral awareness.

As the child ages, speech therapy goals will target speech and language skills. Children with CdLS exhibit a wide range of communication disorders. Preverbal assessment of communication skills and early intervention are recommended. For some children with CdLS, augmentative or alternative communication may provide them with the most communication success. A speech-language pathologist can determine if a communication device is needed, what device will best fit the child, and how to teach the child to use the device. Beginning speech therapy at an early age will provide each child with the opportunity to meet his or her full communication potential.

Awareness of stuttering has grown nationwide with the recent premiere of the movie The King’s Speech. Since information was provided in an earlier issue regarding stuttering, I would like to talk about a lesser known fluency disorder called cluttering. The American Speech-Language-Hearing Association defines cluttering as a “fluency disorder characterized by a rapid and/or irregular speaking rate, excessive disfluencies, and often other symptoms such as language or phonological errors and attention deficits”. Individuals who stutter are aware of what they want to say, but there is a breakdown in saying it. Individuals who clutter exhibit disorganized speech, talk in spurts, and seem to be unsure of what they need to say.

A speech-language pathologist can provide evaluation and treatment for children who exhibit both stuttering and/or cluttering. That’s right, they can occur together. During the evaluation process, it is important to evaluate the individual’s fluency, rate of speech, articulation, language, and intelligibility during spontaneous verbal communication tasks and reading tasks. A person who clutters may have highly unintelligible speech due to the rate of speech and disorganization. Individuals who exhibit cluttering often talk better when stressed, exhibit little concern regarding their speech, and may exhibit difficulty with written language.

After the evaluation process, there are different treatment options for stuttering and cluttering. Decreasing the person’s rate of speech is often the primary goal for individuals who clutter since rate control is often very difficult for them. Therapists can use different exercise activities to encourage the child to slow their rate of speech. If cluttering is the child’s only deficit, reducing the rate of speech often helps increase intelligibility.

For individuals who stutter, identifying abnormal breathing patterns and looking into the social pressures/fears that the individual feels when speaking are often primary goals. The cause of the stuttering influences what treatment method will be best for that client. The Stuttering Foundation identifies four factors most likely to contribute to the development of stuttering: genetics, child development , neurophysiology , and family dynamics. Professionals treating individuals with stuttering need to thoroughly evaluate each of these areas before beginning treatment.

If you have any questions regarding today’s topics, please feel free to call our office at (423) 246-4600.

Reprinted with permission of the Kingsport Times-News – May 2011

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