Swallowing Difficulties (Dysphagia)

Swallowing difficulties, medically termed dysphagia, occur when the complex process of moving food, liquid, or saliva from mouth to stomach becomes impaired. You might experience coughing or choking while eating or drinking, a sensation of food stuck in your throat, taking significantly longer to finish meals, or unexplained weight loss from avoiding problematic foods. These changes can profoundly impact your nutrition, hydration, safety, and quality of life.

Dysphagia can affect any stage of the swallow process. Oral phase difficulties involve problems with chewing, controlling food in the mouth, or initiating the swallow. Pharyngeal phase difficulties occur in the throat, where food moves toward the esophagus - this is where aspiration risk is highest. Esophageal phase difficulties involve problems with food passage down to the stomach. Speech-language therapists specialise in assessing and treating oral and pharyngeal dysphagia, working collaboratively with gastroenterologists for esophageal concerns.

The prevalence and seriousness of dysphagia cannot be understated. Research shows dysphagia affects over 50% of stroke survivors initially, with 11-13% experiencing persistent swallowing difficulties six months post-stroke. Progressive neurological conditions increasingly impact swallow function over time. Aging populations face higher dysphagia risk due to normal age-related changes in swallow physiology. Consequences of untreated dysphagia include aspiration pneumonia (a serious lung infection), malnutrition and dehydration, compromised general health, chronic lung disease, choking incidents, and in severe cases, mortality.

Understanding aspiration risk is crucial. Aspiration occurs when food, liquid, or saliva enters the airway instead of traveling safely to the stomach. Some individuals aspirate without coughing - termed "silent aspiration" - making professional assessment essential even when obvious choking symptoms aren't present. Early identification and management of dysphagia significantly reduces aspiration pneumonia risk and maintains nutritional status, supporting overall health outcomes and quality of life. If you're experiencing any swallowing changes, professional evaluation is strongly recommended.

Our dysphagia management approach prioritizes safety while maintaining optimal nutrition and quality of life. Speech-language therapists are recognised internationally as the preferred providers of dysphagia services, working as integral members of interprofessional healthcare teams. As a Te Whatu Ora clinician, coordination with hospital specialists, general practitioners, dietitians, and nursing staff is central to comprehensive dysphagia care.

Treatment begins with a thorough clinical swallowing assessment during your initial 75-minute evaluation. We review your complete medical history, current medications (some medications affect swallow function), nutritional status, and specific swallowing concerns. Clinical examination includes assessment of oral motor function, pharyngeal sensation, voice quality changes that might indicate aspiration, and trial swallows with various food and liquid consistencies. This comprehensive evaluation identifies aspiration risk, determines safe diet consistency levels, and establishes baseline swallow function.

Where clinically indicated, we can arrange instrumental swallowing assessments including Videofluoroscopic Swallow Studies (VFSS) or Flexible Endoscopic Evaluation of Swallowing (FEES). These "gold standard" assessments provide detailed visualization of swallow physiology, definitively identify aspiration, and guide treatment planning. While public wait times for these procedures can be extended, our private practice can facilitate timelier access through coordination with radiology and ENT departments. We interpret results and translate findings into practical, evidence-based treatment recommendations.

Treatment approaches are highly individualised based on your specific swallowing impairment pattern, underlying medical condition, cognitive status, and caregiver support. We might recommend compensatory strategies like modified diet textures (International Dysphagia Diet Standardisation Initiative guidelines), thickened liquids to slow swallow timing, specific head and neck positioning to improve airway protection, smaller bite sizes and slower eating pace, or environmental modifications reducing distractions during meals.

Therapeutic exercises and techniques aim to improve swallow physiology where possible. These might include tongue strengthening exercises, pharyngeal strengthening programs, swallow maneuvers like the supraglottic swallow or Mendelsohn maneuver for airway protection, or sensory stimulation techniques. Research demonstrates that active rehabilitation approaches can significantly improve swallow function, particularly following stroke or surgery. Your commitment to practicing exercises consistently directly impacts outcomes.

Family and caregiver training is essential for dysphagia management. We provide comprehensive education on safe feeding practices, appropriate food preparation and presentation, positioning techniques maximizing swallowing safety, recognising signs of aspiration or choking, and emergency response procedures. Empowering caregivers with knowledge and practical skills ensures safety between therapy sessions and promotes confidence in mealtime management.

Ongoing monitoring and adjustment are crucial, especially with progressive conditions. We track your nutritional status, hydration adequacy, respiratory health (repeated chest infections suggest aspiration), and swallow function changes over time. Treatment plans evolve as your condition improves or progresses, ensuring recommendations remain appropriate for your current swallow capacity. Regular communication with your healthcare team ensures everyone remains informed about your dysphagia management status.