ARTICLES / General /
Understanding Dysphagia /
Jeri Logemann, Ph.D., Charles A. Stewart, M.D.,
Jane Hurd, MPA,
Diane J. Aschman, MS,
Nancy L. Matthews, MA
Recognition, Education, Control
a variety of causes and can manifest in a
variety of ways. To identify the problem, the
right questions need to be asked in easily
understood language. It may also be necessary to
eliminate some common myths and
misunderstandings. Education, therefore, is a
key element in bringing dysphagia under control.
This can begin with an understanding of the
swallowing process itself.
In Picture A, a morsel of food
has been chewed and is ready to enter the throat.
The food then pushed toward the back part of the
mouth, against the muscles of the pharyngeal wall as
seen in Pictures B and C.
In Pictures D and E, the airway
lifts and closes off when the soft pallet closes,
protecting the entrance to the nose. Then the
entrance to the esophagus opens, allowing food to
bypass the airway and enter the esophagus.
Finally, in Picture F the food
passes down the esophagus. The airways reopen to
allow continued breathing.
When this sequence is disrupted at any point,
dysphagia can result. Because individuals may seek
to avoid the embarrassment of coughing or choking
during meals, they isolate themselves to the extent
that early signs go unrecognized. In making the
diagnosis, itís important to be aware of conditions
such as Parkinsonís or gastro-esophageal reflux
(GERD), which can heighten vulnerability. Dysphagia
may also arise as a side effect of medication often
used for arthritis, Parkinsonís disease, depression
and other common conditions.