SWALLOWING DISORDERS

Swallowing disorders can seriously affect your ability to eat and get enough nutrition.  They can also make you choke or aspirate material into your lungs, which can be life-threatening.  Here are some ideas based on current research and best practices for helping if you have swallowing problems.  Recent research done in August 2020 shows that to improve quality of life, the swallowing problem to focus on is in the pharyngeal phase. (pubmed.gov, 32846813).  


TREATMENT FOR SWALLOWING DISORDERS


BE AWARE OF SIGNS OF ASPIRATION INDICATING THAT SOMETHING MAY HAVE GONE DOWN THE “WRONG WAY” INTO THE AIRWAY:  coughing, choking, gagging, throat clearing, runny nose, teary eyes, reddening face, or breathing changes. 

IF YOU HAVE A GENERAL WEAKNESS CAUSING BILATERAL REDUCTION IN PHARYNGEAL CONTRACTION (coughing after swallow because of residue in valleculae or pyriform sinus; feeling of food sticking in the throat), try 2, 4, 10, 11, 13, 14, 16, 17, 19.

IF YOU HAD A 1-SIDED STROKE OR HAVE UNILATERAL PHARYNGEAL PARALYSIS (sensation of food sticking in the throat because of residue in valleculae or pyriform sinus; aspiration after the swallow), try 7, 10, 14, 19.

IF YOU HAVE A CERVICAL OSTEOPHYTE (a bony overgrowth of one of the cervical vertebra, which causes sensation of food sticking, pain on swallows, or difficulty swallowing it down), try 1, 4, 9.

IF YOU HAVE REDUCED LARYNGEAL ELEVATION (which causes coughing after the swallow, coughing up food), try 9, 14, 15, 17, 19.

IF YOU HAVE REDUCED LARYNGEAL CLOSURE AT THE AIRWAY ENTRANCE (which causes coughing and aspiration during the swallow), try 9, 13.14.

IF YOU HAVE REDUCED LARYNGEAL CLOSURE AT THE VOCAL FOLDS (which causes coughing and aspiration during the swallow), try  6, 7, 9, 14.

IF YOU HAVE HAVE TONGUE PROBLEMS (which cause difficulty moving food to chew or swallow it, so food stays in your mouth), try 8, 12, 23, 25.

IF YOU HAVE LIP PROBLEMS (which cause food, drink, or saliva to spill out your mouth), try 26

IF YOU HAVE A WEAK SOFT PALATE  (that doesn’t  push strong enough against the base of your tongue so food drips down prematurely), try 18

IF YOU HAVE HAVE SENSORY PROBLEMS (so you can’t initiate a swallow so food stays in your mouth), try 20, 21, 22.

IF YOU HAVE AN INJURY IN YOUR THROAT (trauma, scratches, rubbing/scraping, burns, pain, etc. from tubes, chemicals, smoke, heat, etc.), try 1, 4, 9. 

IF THE ESOPHAGUS DOESN’T RELAX ENOUGH TO OPEN TO LET FOOD IN, OR THERE IS A BLOCKAGE IN THE ESOPHAGUS, there may be a feeling of being unable to swallow any more down, regurgitation, coughing, gurgly voice, or excessive secretions. Try 1, 4, 9, 27.

 

RECOMMENDATIONS:  

▢ 1. Thin / Regular liquids - they require less strength/pressure to squeeze down.

▢ 2. Thickened liquids (nectar-thick or thicker) - they go down slow enough to control, without splashing.  

▢ 3. Regular or Mechanical soft foods

▢ 4. Pureed or chopped foods (apple sauce, pudding, jello, mashed potatoes, etc.)   

▢ 5. Sit Upright for the most natural swallowing position.   

▢ 6. Head down while swallowing to constrict the throat so less goes down, slower and safer.   

▢ 7. Turn head to weak side so the good side is the one to squeeze food down.

▢ 8. Tilt head to good side (ear to shoulder) for gravity to pull food to the good side of your mouth.

▢  9. Take small bites / sips (to prevent choking on too much material at once).

▢  10. Alternate food and liquid swallows (to clear the thicker sticking residue).

▢  11. Do Dry Swallows - Swallow multiple times after every bite (to clear all the residue).

▢  12. Do Effortful Swallows. Swallow strongly (to pull the tongue further back and clear the residue).

▢  13. Hold your breath while swallowing (to prevent material from going down the wrong way).

▢  14. Do Supraglottic Swallow - When ready to swallow, take a deep breath, swallow while holding your breath, and cough immediately without breathing in. (This closes the airway entrance to prevent material from going down the wrong way, then blows out any residue).

▢  15. Do Mendelsohn Maneuver - While swallowing, keep your voice box up for a few seconds, not letting it drop.  (This widens the opening to your esophagus, letting more material in).  A falsetto exercise helps too.

▢  16. Exercise with the Masako maneuver - Hold your tongue between the teeth with the tip out ¼ inch and swallow. You should feel a strong pulling forward of the back of the upper throat. (This exercises the glossopharyngeus muscle to eventually produce a stronger swallow).

▢  17. Voluntarily cough or clear your throat after swallows (to clear out any residue from the airway entrance).  

▢  18.  Exercise your soft palate: keep cheeks puffed while breathing through nose, blow through a pinched straw, transfer water with a straw to another container without losing any.  

▢  19. Swallow frequently throughout the day (to exercise by using the muscles and gradually strengthen them for a better swallow).  

▢  20. For sensory problems, increase sensation by foods/drinks that are sour, cold, hot, chewable, carbonated, or very delicious. Ice helps too. (These stimulate the nervous system to send a signal to swallow and work better).

▢  21. Push the tongue down with a spoon (to stimulate the muscle to work to swallow).  

▢  22. Do an exaggerated suck-swallow with lips closed (to help trigger the swallow).

▢  23. Exercise the base of the tongue:  Try to yawn, gargle, pull tongue back, or strongly say /k/ sounds in words.

▢  24. Airway closure exercises:  Hold breath and “bear down” while pushing or pulling 1 sec., or fast “ah” glottal attacks, or hold “ah” 5 sec., or hold breath-swallow-cough.

▢  25. Tongue movement/control Exercises:  Open mouth and push tongue up to palate, stretch it to both sides of mouth, stick out far and pull in deep, push against a stick, manipulate a candy in your mouth and hold it on the center of your tongue.  

▢  26.  Lip Exercises:  Tightly say “ee” or “oo”, press lips tight together, hold lips together several minutes, close them against a resistance, and resist the prying of your lips open. 

▢  27. Wait for a while between swallows - the material may go down at its own speed.

▢  28. OTHER: