Swallowing is a complex process. It is partly under voluntary control and partly automatic.
Stages in a normal swallow:
- Food or drink is taken into the mouth
- The lips, jaw and tongue work together to chew the food or hold the drink in place and then move it quickly to the back of the mouth
- The mouthful is moved towards the pharynx (throat) and muscles start to squeeze it down
- The opening of the oesophagus (gullet) and the top of the trachea (windpipe) are very close in the throat. The larynx (voice box) lifts up and the epiglottis comes over to close the opening into the trachea and lungs.
- The opening of the oesophagus relaxes and the bolus (mouthful) goes down and into the stomach by a process known as peristalsis.
There are five nerves and many muscles involved in a single swallow.
If you have dysphagia (difficulty swallowing) there may be a problem at any of these stages. A trained Speech and Language Therapist can assess you.
What is the purpose of the assessment?
With your agreement, the Speech and Language Therapist will aim to establish the nature of the difficulty, if there are any risks to your health, and whether there are some things that could help.
What will the assessment involve?
The therapist will need to ask you some questions. For example, about your general health and how the difficulties started.
They will need to have a look in your mouth and may ask to feel your throat as you swallow. This will involve putting their fingers gently on your neck.
Sometimes it is helpful to use a stethoscope to hear the sounds of swallowing. This can give the therapist more information than just looking and feeling. The stethoscope is placed on the throat near the Adam's Apple.
A pulse oximeter may be used. This measures the oxygen saturation of your blood. It has a probe which clips gently onto your finger.
The therapist may ask you to eat or drink while they watch, listen and feel what is happening.
As a result of the assessment the therapist may recommend that you:
- change the type of food you eat
- change the way you eat
- do some exercises for your mouth or throat
- have further tests
The therapist will discuss their findings with you and answer any questions you may have. A report will be written for your GP and you will also receive a copy.
Difficulty swallowing may be of concern to your general health and it can lead to dehydration and weight loss. There may also be a risk to the health of your lungs.
If the swallow goes wrong food or drink can get into your trachea and your lungs. Any food and drink is a foreign substance to the windpipe and can block up the branches and lead to a chest infection.
If this continues or if a substantial amount goes the wrong way, you can develop what is known as aspiration pneumonia. This is very serious.
Bacteria in saliva can also lead to such an infection so keeping your teeth or dentures clean is vital.
If you are chesty, hear crackly breathing or a bubbly wet voice, or are producing yellow-green phlegm then contact your GP straight away – these are signs of a possible chest infection.