Swallowing Difficulties

Swallowing is an every but important function that is integral to eating and drinking. Patients who experience difficulties in swallowing include:

• People who have had a stroke or head injury that has resulted in difficulty swallowing.
• People who have had head and neck surgery and are having difficulty eating and drinking.
• Anyone who is experiencing difficulties in eating and drinking due to their medical condition.

How can swallowing exercises help?

• Lip and tongue exercises will help to strengthen the muscles for chewing and keeping food in your mouth
• Exercises for the muscles in your throat will help to strengthen these muscles
• You may also be taught to do some swallowing manoeuvres, head tilts and turns, which will help you to swallow.

What are thickened liquids?

Thickened liquids are liquids, which are thickened to different consistencies with a starch-based powder e.g. Thick & Easy and Thicken up. You may be advised to thicken your liquids because you choke/ cough on normal thin fluids. Your swallowing muscles need to work very quickly to swallow normal liquids. If you have a swallowing difficulty, your muscles may not react fast enough to swallow and some of the liquid may go into your airway and cause you to cough.

Some people with swallowing difficulties do not always cough when some liquid goes the wrong way, which makes it more dangerous for them to drink normal liquids.By thickening the liquid, it will go down more slowly when you swallow and help to reduce those coughing episodes and the likelihood that the liquid will go into your airway.

What is Aspiraton?

Aspiration is entry of food or liquid into your airway. The normal response if food goes into the airway is coughing. Some patients may not cough if food / liquid goes into the airway.

What is a feeding tube?

There are different types of feeding tubes. These can generally be divided into 2 groups:

• Naso-Gastric tube (N.G)
• P.E.G ( Percutaneous Endoscopic Gastrostomy)

An N.G. tube is inserted via the nose through the throat and into the oesophagus (food pipe). It must be changed every 2 - 3 weeks. Certain types of N.G tube e.g. a Frecka's tube can remain in place for up to 2 months before changing.

A P.E.G is inserted directly into the stomach via a small incision in the stomach wall. The first change is usually after 6 months and thereafter it can remain in place for up to 1 year.

Special nutritionally balanced milk is fed via the feeding tubes to meet your specific needs. You must ensure that you put the correct amount of milk into the tube. Too little can result in poor nutrition and poor hydration. Always follow the instructions given to you by the medical staff.

Why do I need a feeding tube?

You will need a feeding tube if because of your swallowing difficulties you are unable to eat and drink the normal way i.e. through your mouth.

• Coughing during eating and drinking or shortly after eating / drinking
• A wet / gurgly voice during or after eating
• A tendency to hold food or drink in the mouth for prolonged periods of time
• Difficulty eating hard, chewy or crumbly foods
• Shortness of breath induced by eating or drinking
• A long time taken to eat or drink - e.g. 45 minutes - 1 hour
• Loss of weight because of a prolonged eating time, poor appetite or avoidance of certain foods.
• Recurrent chest infections or pneumonia requiring hospitalisation
• Drooling of saliva or inability to swallow ones own secretions
• Refusal to eat

The Speech Therapist will take a case history of your swallowing difficulties and assess your swallowing in the clinic. The therapist may send you for:

• Videofluoroscopy
• FEES (Fibreoptic Endoscopic Examination of Swallowing)

Videofluoroscopy

• It is a swallowing assessment using a x-ray so that we can see you chewing and swallowing the food and liquids.
• You will be asked to eat small amounts of a soft food, biscuit / bread, thickened liquid and liquid. A white powder called barium will be mixed into the food so that we can see the food when you swallow it.
• The examination will be recorded on videotape so that the speech therapist can review the tape later and also show it to the patient.

FEES (Fibreoptic Endoscopic Examination of Swallowing)

• This is a swallowing examination using a fiberoptic endoscope.
• The scope is inserted through you nose to enable the examiner to see your throat.
• You will be given some food and liquids mixed with blue food colouring to eat/drink so that we can assess your swallowing.

Based on the results of the assessments, the therapist will be able to tell you:

• Why you are having swallowing problems.
• Advise you on the most suitable food consistencies to eat and any head positions that may help while you are swallowing.
• Give you some swallowing exercises to practice.
• Advise whether you need tube feeding.