Maybe dinner takes a long time for someone at your table, and you’ve started to notice the cough that turns up halfway through every meal. Maybe it’s your own swallow, and you’ve caught yourself thinking “why does it feel like it gets stuck?” Either way, you’re in the right place, and none of this needs to be worked out tonight. This guide explains what dysphagia means and what a Speech Pathologist can do about it.
01 · The fundamentals
Defining Dysphagia: What Is It?
Dysphagia is the medical name for difficulty swallowing. It can affect any part of the swallow, from holding food in your mouth to moving it down into your stomach. Around 1 in 5 Australians over 50 experience it, and Speech Pathologists assess and treat it.
Swallowing feels like one action, but it happens in four stages. First you chew the food and mix it with saliva. Then your tongue moves it to the back of your mouth. Then your throat takes over, closing off your airway and pushing the food through quickly. Last, the oesophagus, which is the tube behind your windpipe, carries it down to your stomach. Dysphagia means one or more of those stages is not working the way it should.
That’s why dysphagia is a symptom and not a diagnosis. It always points to something else, and finding that something comes first, because it shapes everything a Speech Pathologist does next.
Finding the cause comes first, because it shapes everything that follows.
02 · The signs
Signs To Look Out For: Difficulty Swallowing
Some signs are obvious, and some are easy to mistake for habits. The obvious ones are:
- Coughing or choking while eating or drinking
- A wet or gurgly sounding voice after a swallow
- Pain when swallowing
- The feeling of food catching in the throat or chest
The quiet ones are easier to put down to habit:
- Eating more slowly than everyone else at the table
- Taking two or three swallows for one mouthful
- Avoiding foods like steak, bread or mixed soups
- Holding food in the cheek, or drooling
- Losing weight without trying to
Have you noticed someone has quietly stopped eating with the family? Long, tiring mealtimes and a preference for eating alone are often the first thing a partner or a parent picks up, well before the person mentions it themselves. In one large survey, about half of the adults who reported difficulty swallowing had never raised it with a clinician. A swallow that has gone unmentioned for a while is common, and it’s a very ordinary place to be starting from.
Babies and children show it differently. Coughing or spluttering during feeds, gagging on textures, very long mealtimes and slow weight gain can all be part of the picture, and so can being labelled a fussy eater. Those are worth raising with your GP or a Speech Pathologist early, because feeding is often easier to work on while a child is small.
03 · Anterior spillage
What Is Anterior Spillage?
If you’ve watched tea dribble from the corner of someone’s mouth, or food fall back onto the spoon before it can be swallowed, you’ve seen what Speech Pathologists call anterior spillage. It means food or drink is escaping from the front of the mouth, and it’s a sign that the first stage of the swallow, the oral stage, is affected.
The lips, cheeks, tongue and jaw normally work together to take food in, keep it in, chew it and send it backwards. When there’s anterior spillage, one of those jobs isn’t being done fully. The common reasons are:
- Weak lip closure, often after a stroke or with a facial nerve problem
- Reduced tongue control
- Reduced feeling in the lips or tongue
- Dentures that no longer fit
- Posture, because a head tipped back or a slumped trunk makes holding food in much harder
- Awareness, because for some people living with dementia or a brain injury the muscles work but the brain isn’t registering the food in the mouth
A Speech Pathologist looks at lip strength and seal, tongue movement, cheek tone and sensation, and then watches you eat something you would normally eat. Treatment depends on which of those is the cause. It usually combines targeted lip and tongue exercises with practical changes like smaller mouthfuls, a slower pace and an upright seated position, and where it helps, a change of texture, all of which go into the person’s mealtime management plan. For people with a progressive condition, the focus is on eating comfortably and with dignity.
04 · The causes
Causes and Early Warning Signs: Dysphagia
Dysphagia has many causes, and none of them is a habit you picked up. The most useful way to sort them is by what they mean for what comes next, because that’s usually what you really want to know.
Sudden causes
Stroke is one of the most common causes of new swallowing difficulty in adults. Around half of people who have a stroke have some difficulty swallowing early on, and the figure is higher again when it is measured with imaging rather than by watching. Brain injury sits in the same group. With sudden causes, therapy runs alongside whatever recovery the brain makes on its own in the weeks and months that follow.
Progressive Causes of Dysphagia
Parkinson’s disease, motor neurone disease, multiple sclerosis and dementia change the swallow gradually. About 1 in 3 people with Parkinson’s notice a swallowing change. When it is measured directly, the figure is closer to 4 in 5, which tells you how often it goes unmentioned. Here the aim of treatment is to stay ahead of the change, with safe textures and strategies that suit the current swallow, reviewed regularly as things shift.
Lifelong causes of Dysphagia
Cerebral palsy, Down syndrome, cleft palate after repair, and prematurity can all affect how a child learns to suck, chew and swallow. Sensory feeding differences, which are common in autistic children, sit here too. For a child, the work is developmental. It means building the skills at the child’s pace, with the family doing most of the practice at home.
Age-related change
Swallowing muscles lose some strength with age, and clinicians call the ordinary age-related version of this presbyphagia. It becomes a problem when it stacks up with other things, like a dry mouth from medication, tiredness or a chest infection. As many as half of people living in residential aged care have some degree of dysphagia, which is why mealtime support matters so much in that setting.
Structural causes
Head and neck cancer and its treatment, a narrowed oesophagus, reflux damage and a hiatus hernia can all physically get in the way of the swallow. These usually involve your GP and a medical team as well as a Speech Pathologist, because part of the treatment may be medical rather than therapy.
05 · What works
How Does a Speech Pathologist Assess and Treat Dysphagia?
A swallowing assessment is calmer than most people expect. Your Speech Pathologist starts by listening: when the difficulty started, what has changed, what you can and cannot manage, and what else is going on medically. Then they look at the muscles involved, which means lip seal, tongue strength and movement, the soft palate and your voice. Then they watch you swallow, starting with water and moving through thicker drinks and different food textures. They are looking for a cough, a throat clear, a change in your voice, or food left behind in the mouth.
For many people, that clinical assessment gives your Speech Pathologist everything they need to plan treatment. Where more detail is needed, your Speech Pathologist can arrange an instrumental study through the hospital system. One option is a videofluoroscopy, which is a moving X-ray of the swallow. The other is a FEES study (fibreoptic endoscopic evaluation of swallowing), where a thin camera passed through the nose gives a direct view of the throat as you swallow.
What goes into a mealtime management plan
Treatment is built from the assessment and written up as a mealtime management plan, which usually has three parts. The first is texture. Australian Speech Pathologists describe food and drink using the IDDSI framework, which has eight levels numbered 0 to 7. That way “mildly thick” or “minced and moist” means the same thing in your kitchen, in hospital and in aged care. The second is strategies, like a chin tuck, a deliberately effortful swallow, or a second swallow to clear the throat. Each one is matched to what the assessment found, because a strategy that helps one swallowing pattern can make another one less safe. The third is exercise for the swallowing muscles themselves, such as tongue strengthening or the Shaker head-lift, when weakness is the driver.
So will it go away, and is all of this worth doing? For sudden causes, stroke trials suggest swallowing therapy may reduce the number of people who still have dysphagia at the end of treatment, and may lower the chance of a chest infection, though the evidence for both is low certainty. For progressive causes the goal is different, and it’s about staying safe and comfortable as things change. For children, progress is measured in skills gained. Whatever the cause, your Speech Pathologist will tell you what progress is realistic for you and will review it with you as you go.
06 · Your next step
When Should You See a Speech Pathologist About Swallowing Difficulties
An occasional cough on a crumb, or a tablet that goes down the wrong way, doesn’t need an assessment. The pattern is what matters. It’s worth booking one when:
- Coughing or choking is happening at most meals
- Weight is dropping without a reason
- Chest infections keep coming back
- Mealtimes have become long or stressful
- Swallowing has changed after a stroke, a new diagnosis, or a shift in how a child feeds
Optimum Health Solutions’ Speech Pathologists assess and treat dysphagia in adults and children, at clinics across New South Wales and Tasmania, at home, at school and in the community. Swallowing assessments can be funded through the NDIS, with a Medicare rebate under a chronic condition management plan, or privately. The assessment page explains the funding options and what a swallowing assessment involves on the day, and you can meet the team before you book.
If swallowing is getting harder for you or for someone you care about, you don’t have to work out the cause on your own. That’s what the assessment is for.
