Swallowing is a process that all of us take for granted without understanding the complicated processes lying underneath for its smooth functioning. With age the swallowing function can deteriorate leading to many eating challenges, which can, in turn, lead to issues like malnutrition, dehydration, weight loss and even aspiration pneumonia. It is estimated that 20 per cent of individuals over the age of 50 and most of the individuals over the age of 80 years have some form of swallowing issues, medically termed as Dysphagia. An assessment and intervention by a specialised ENT doctor can help alleviate some of the problems with simple techniques like muscle strengthening exercises, change in consistency of food etc.
Dr. Sanjay Subbaiah, Fellow in Phonosurgery and Specialist in Voice & Swallowing problems, MS ENT Center, Bangalore explains Dysphagia, its cause and effect and tells us about possible ways of treating them.
Swallowing is a semiautomatic process where an individual transports food from the mouth to the stomach. A normal person swallows roughly about 1500 times a day. The process starts with chewing of the food in the mouth, later this bolus [chewed food] is pushed to the back of the mouth. Until this step it is a voluntary activity. From here the involuntary part of swallowing starts. Next as the bolus enters the pharynx, this entry is synchronized with the closing of the wind pipe [Larynx] and opening of the food pipe [Oesophagus], so that bolus is pushed into the opened food pipe. Once in the food pipe peristaltic waves propel the bolus into the stomach.
The second part of the process i.e. the pharyngeal stage where the wind pipe closes and food pipe opens is a highly sophisticated process, requiring the coordination of sensory receptors, nerves, muscles and the central nervous system. This stage witnesses the temporary cessation of breathing and opening of the food pipe [which is otherwise always closed]. Here timing is everything.
Thus we can see that swallowing has 3 stages, the oral stage, pharyngeal stage and oesophageal stage. Problems can occur in one or more stages of swallowing. Derangements in the oral stage can lead to:
- Inability to hold food in the mouth.
- Unable to chew food.
- Unable to push bolus into the back of the mouth [pharynx].
- Bolus entering the nose.
Derangements in the pharyngeal stage are common and dangerous, leading to:
- Wind pipe not closing properly and bolus entering the wind pipe. This leads to aspiration and sometimes even death. In milder forms it can cause recurrent attacks of aspiration pneumonia or coughing during or after eating.
- Food pipe not opening properly causing bolus to accumulate in the pharynx.
- Desynchronization or delay in closing the wind pipe can lead to aspiration.
Derangements in the oesophageal stage can lead to:
- Bolus stagnating in the food pipe causing vomiting.
It is obvious that swallowing is a complicated process and small derangements can cause dangerous consequences. It has been estimated that 20 % of the individuals over the age of 50 yrs. and most of the individuals over the age of 80 yrs. have some sort of swallowing problems. Reduced sensitivity and strength of the receptors, muscles and nerves are thought to be the main culprit. Missing teeth and medications causing dryness of mouth can also add to the problem. Swallowing problems are also seen in individuals suffering from certain nervous disorders and those who have undergone Head and Neck surgery. The common nervous disorders with swallowing problems are Stroke, Motor neurone disease, ALS, Parkinson’s disease, Alzheimer’s disease and tumours of the Brain.
Swallowing problems are called DYSPHAGIA. The consequences of dysphagia are two folds, safety and efficiency issues. Safety issues occur due to bolus or even saliva entering the wind pipe leading to coughing during or after eating, aspiration pneumonia and sometimes even death. Efficiency issues occur due to reduced amount of eating leading to dehydration, malnutrition, electrolyte imbalances and sarcopenia [loss of muscle mass with aging]. Since many elderly people already have some pre-existing diseases these problems only add to the deterioration.
Dysphagia is handled by a Voice & Swallowing specialist, which is a sub speciality of ENT Dept. The standard investigations are, Clinical evaluation of swallowing, Fibro-optic evaluation of swallowing [FEES] and Modified barium swallow. These investigations help in deciphering which stage and process of swallowing is affected so the management is tailor made to the issue.
Dysphagia treatment is broadly divided into Non-surgical and Surgical and depends on the cause, symptoms, and type of swallowing problem.
Non-surgical modalities are:
- Oro Dental care & hygiene.
- Oro motor exercises.
- Neck exercises –Shakers exercises.
- Swallow manoeuvres.
- Swallow Postures.
- Consistency adaptation of food.
- Nasogastric tube.
Surgical modalities include:
- Percutaneous gastrostomy [PEG].
- Medialization laryngoplasty.
Hence any elderly individual with following symptoms must visit a specialist at the earliest for a swallowing assessment.
- coughs while/ after eating or drinking;
- chokes on food, fluid, or medication;
- has difficulty swallowing food or fluid
- has recurrent attacks of pneumonia
- is dehydrated and has electrolyte imbalance
- is malnourished and facing loss of muscle mass
After swallowing assessment depending on what stage of swallowing is impaired, tailor made treatment is started. Most of the times it is managed by exercises and manoeuvres. Rarely surgical methods are employed.
Visit a specialist today and regain the pleasures of eating.