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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