Neurologic Dysphagia

Swallowing is a complex process involving the coordination of many nerves and muscles. Several neurologic conditions can interfere with this process, causing difficulty swallowing (dysphagia). Oropharyngeal dysphagia is a type of dysphagia that involves difficulty moving food and liquids from the mouth to the throat and esophagus. The muscles of the mouth, back of the throat (pharynx), and top of the esophagus (upper esophageal sphincter) are connected to the brain and can be weakened in people with neurologic disorders.

Symptoms of Neurologic Dysphagia

If you have oropharyngeal dysphagia, you may experience pain, choking, gagging, or coughing when you try to swallow. You may have the sensation of liquids or solids “going down the wrong pipe” (into the airway) or going up into the nose.

Dysphagia can take the joy out of eating and drinking and can lead to complications such as malnutrition, weight loss, and dehydration. In addition, patients who aspirate liquids or solids (breathe them into the airway) can develop pneumonia, bronchitis, or other upper respiratory infections. 

Causes of Neurologic Dysphagia 

The most common neurologic cause of oropharyngeal dysphagia is stroke, but other causes include traumatic brain injury, cerebral palsy, Parkinson’s disease and other degenerative neurological disorders, muscular dystrophy, and myotonic dystrophy.

Diagnosing Neurologic Dysphagia

To diagnose oropharyngeal dysphagia your doctor may perform two or more of the following tests:

• Videostroboscopy: In this test, doctors use a lighted camera called an endoscope to see the larynx. They may use either a flexible endoscope (inserted through the nose and over the back of the throat) or a rigid endoscope (inserted through the mouth).
• Esophageal manometry: This test measures how well the muscles in your esophagus work when you swallow. After your throat and nose are numbed, a thin, flexible tube with sensors is passed through the nose, down the esophagus, and into the stomach. You will be asked to sip water during the test.
• Modified barium swallow study (MBS): During this test you will swallow a variety of substances coated with barium, a whitish paste that lights up during an x-ray. This lets the examiner see how substances move through the mouth, pharynx, and esophagus.
• Flexible endoscopic evaluation of swallowing (FEES): In this test, your doctor will pass a small, flexible fiberoptic scope through the nose and hold it above the larynx to watch food and liquid as they are swallowed.

Treatments for Neurologic Dysphagia

When choosing the best treatment, your doctor will consider the type and severity of your swallowing disorder. In some cases, dysphagia can be corrected using diet or non-invasive methods. In others, especially when the dysphagia is causing aspiration and preventing adequate nutrition, it may require aggressive treatment, such as a feeding tube. Two important treatment goals are to make sure you are getting enough nourishment and to reduce your risk of pneumonia.

For those with progressive degenerative neurological disorders, dysphagia will be one of several symptoms that have to be treated.

Treatments for dysphagia may include:

• Dysphagia therapy: A speech and language pathologist provides exercises to strengthen the swallowing muscles and re-coordinate the timing of the swallow.
• Diet changes: Your doctor will recommend a personalized diet plan that may include thickened liquids and pureed foods.
• Feeding tube: In severe cases, a swallowing disorder can lead to an inability to eat or drink enough to maintain proper nutrition. In these cases, a feeding tube is placed.

Why Choose Columbia

At Columbia, our expert team evaluates people who are having difficulty swallowing to find the root cause of the problem and offer innovative treatments to help you return to your best health. When you meet with our specialists, they will teach you exercises to stretch and strengthen the swallowing muscles. Since neurologic dysphagia might be a long-lasting condition, our team works to minimize its impact on your daily life.