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Neurologic Dysphagia

Neurologic Dysphagia

What is neurologic dysphagia?

Swallowing is complex process involving the coordinated interactions of a network of nerves and muscles, and a number of neurologic conditions can interfere with this process, causing disordered swallowing (dysphagia). The muscles of the mouth, back of throat (pharynx), and top end of the esophagus (upper esophageal sphincter) are directly connected to the brain through the cranial nerves, and can be weakened in people with neurologic disorders. When people have difficulty timing the movement of food and liquids from the mouth to the throat and esophagus when they start to swallow, they have a specific form of swallowing disorder called oropharyngeal dysphagia. The most common neurologic causes of oropharyngeal dysphagia is stroke, but other causes include traumatic brain injury; cerebral palsy; Parkinson disease and other degenerative neurological disorders; muscular dystrophy and myotonic dystrophy.

What are the symptoms of neurologic dysphagia?

People with oropharyngeal dysphagia may experience pain, choking, gagging, or coughing when they attempt to swallow. They may have the sensation of liquids and/or solids “going down the wrong pipe” (into the airway) or going up into the nose. Frequent episodes of liquids/solids going into the airway may lead to pneumonia.

How is neurologic dysphagia diagnosed?

To diagnose oropharyngeal dysphagia doctors will probably perform two or more of the following tests:

  • Videostroboscopy: In this test doctors use a camera called an endoscope to visualize the larynx. Using a flexible endoscope, a small flexible camera, they can look up through the nose and over the back of the throat. Using a rigid endoscope, a slightly larger, but still small, firm camera, they can examine the via the mouth. Both endoscopes use light sources called strobe lights that allow the physicians to view the larynx, and both tests take only a few minutes to complete.
  • Esophageal Manometry: An esophageal manometry measures the rhythmic muscle contractions, and the coordination and force exerted by the muscles, that occur in the esophagus when a person swallows. During this test, a thin, flexible tube (catheter) that contains sensors is passed through the nose, down the esophagus, and into the stomach. (The throat and nose are numbed for this test.) Patients will be asked to take small sips of water and swallow on command during the test.
  • Modified Barium Swallow Study (MBS): During this test patients are asked to swallow a variety of substances that are coated with barium, a whitish paste that lights up during an X-ray, enabling the examiner to determine how well these substances are moving through the mouth, pharynx, and esophagus. The test will show if the upper esophageal sphincter is not relaxing or if foods or liquids are blocked as they pass through the esophagus.
  • Flexible Endoscopic Evaluation of Swallowing (FEES): FEES is an instrumental examination of swallowing that allows the examiner to view food and liquid as it passes through the throat. Doctors pass a small flexible fiberoptic scope through the nose and hold it above the larynx to view the swallow.

How is neurologic dysphagia treated?

Treatments for neurologic dysphagia vary greatly depending on the type and severity of a patient’s dysphagia. Ensuring that patients get adequate nourishment and reduce their risk of pneumonia or other pulmonary infections are two key considerations. Treatments for dysphagia may include (but are not limited to):

  • Dysphagia therapy: A speech and language pathologist provides exercises and strategies to help strengthen the muscles of swallowing, re-coordinate the timing of the swallow, and encourage a safe and effective swallow.
  • Diet modifications: In this highly individualized approach the physician recommends various diet modifications, which may include thickening liquids, eating purees, etc.
  • Feeding tube: In the most severe cases, a swallowing disorder can lead to an inability to eat or drink completely or not enough to maintain proper nutrition. In these cases, a feeding tube is placed.

What are the complications of neurologic dysphagia?

Dysphagia can take the joy out of eating and drinking, and can lead to more severe complications such as malnutrition, weight-loss, and dehydration. In addition, if you are aspirating liquids or solids (breathing them into the airway while swallowing), respiratory problems such as pneumonia, bronchitis, or other upper respiratory infections can result.

What is the outlook for people with neurologic dysphagia?

The prognosis for people with neurologic dysphagia depends upon the type of swallowing problem they are experiencing, and the course of the neurological disorder that produces it. In some cases, dysphagia can be partially or completely corrected using diet manipulation or non-invasive methods. In others, especially when the dysphagia is causing aspiration and preventing adequate nutrition and causing weight loss, it may require aggressive intervention such as a feeding tube. For those with progressive degenerative neurological disorders, dysphagia will be only one in a cluster of symptoms and disabilities that have to be treated.