The symptoms of this condition are diverse and include repetitive swallowing, throat clearing, garbled and/or hoarse voice, recurrent pneumonia, deglutitive cough, weight loss, choking, avoidance of social dining, and food sticking.
A stroke can affect the muscles we use to eat and swallow. These muscles may include your lips, your tongue, and the muscles in your throat. Some swallowing problems are easy to see like drooling, coughing or choking. Others may be harder to see.
If your stroke damages the parts of your brain that do this, then this will affect your ability to swallow. Swallowing problems are also known as dysphagia. If your balance has been affected, you may not be able to sit up straight, which can make swallowing more difficult.
Over half of stroke survivors experience dysphagia after their stroke event. Thankfully, the majority of survivors “recover swallowing function within 7 days, and only 11-13% remain dysphagic after six months.”
In patients with significant dysphagia and dementia we know that survival is equally short with and without a feeding tube, around 6 months.
Dysphagia can be classified into four categories, based on the location of the swallowing impairment: oropharyngeal, esophageal, esophagogastric, and paraesophageal (Figure 82.1). These four types occur in four separate but continuous anatomic areas.
Being diagnosed with dysphagia (swallowing difficulties) can be frightening. Enjoying a full, meaningful life when you have trouble eating, drinking and swallowing might seem unrealistic, but many Australians can and do live successfully with dysphagia.
Benign strictures typically progress slowly (over a period of months to years) and are associated with minimal weight loss. Malignant esophageal strictures usually cause rapidly progressing dysphagia (over a period of weeks to months) with substantial weight loss.
If untreated, dysphagia can cause patients to aspirate food and liquid into the lungs, leading to infections, aspiration pneumonia, and death.
Difficulty talking or swallowing.
A stroke might affect control of the muscles in the mouth and throat, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language, including speaking or understanding speech, reading, or writing.
Many cases of dysphagia can be improved with treatment, but a cure isn't always possible. Treatments for dysphagia include: speech and language therapy to learn new swallowing techniques.
Hemorrhagic strokes are more frequently associated with dysphagia than ischemic lesions.
Considerable pain on swallowing is not a typical feature of stroke-related dysphagia and therefore the presence of pain should prompt further investigation, such as endoscopy. Once a foreign body causing dysphagia, dysphonia and sore throat has been removed, recovery of symptoms can be rapid.
You should see your doctor to determine the cause of your swallowing difficulties. Call a doctor right away if you're also having trouble breathing or think something might be stuck in your throat. If you have sudden muscle weakness or paralysis and can't swallow at all, call 911 or go to the emergency room.
Dysphagia can be serious. Someone who cannot swallow safely may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight. Food pieces that are too large for swallowing may enter the throat and block the passage of air.
Oral preparatory phase.
During this phase, you chew your food to a size, shape, and consistency that can be swallowed. This is called a bolus.
It's easy for elderly adults to become dehydrated when they suffer from dysphagia. If they can't drink plain water, they might just not drink anything at all. In order to help your loved one stay hydrated, their drinks will need to be thickened.
A dry mouth can make dysphagia worse. This is because you may not have enough saliva to help move food out of your mouth and through your esophagus. A dry mouth can be caused by medicines or another health problem.
Consequences of dysphagia include malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death. Adults with dysphagia may also experience disinterest, reduced enjoyment, embarrassment, and/or isolation related to eating or drinking.
Esophageal dysphagia is diagnosed with a variety of tests, and can often be alleviated with minimally invasive surgical or endoscopic procedures.
Pharmacologic Treatment
Diltiazem: Can aid in esophageal contractions and motility, especially in the disorder known as the nutcracker esophagus. Cystine-depleting therapy with cysteamine: Treatment of choice for patients with dysphagia due to pretransplantation or posttransplantation cystinosis.
Patients with dysphagia have difficulty swallowing oral medications. Swallowing aid foods, such as deglutition aid jellies and food thickeners, are often used to help such patients take oral medications. Yogurt is occasionally used to help swallow medications.
Difficulty swallowing can lead to: Malnutrition, weight loss and dehydration. Dysphagia can make it difficult to take in enough nourishment and fluids. Aspiration pneumonia.