Dysphagia can have various causes and predominantly affects older people. The degrees of severity range from mild discomfort to complete inability to swallow. If the swallowing reflex is impaired and the cough reflex is absent, eating and drinking can become life-threatening. The swallowing process is a complex process that can be controlled consciously in some cases and involuntarily in others. Up to 2000 times a day, an adult swallows saliva, food and liquid with the help of about 50 pairs of muscles.
Dysphagia: symptoms and causes
Acute, painful dysphagia is probably familiar to almost everyone as a troublesome side effect of irritated tonsils during a cold infection. Allergic reactions (e.g., after an insect bite) can also lead to swelling of the mucous membranes and thus dysphagia. A typical symptom is dysphagia in the rare but life-threatening tetanus. The causes of chronic dysphagia are varied and may involve one or more phases of the swallowing process.
- The most common cause is a neurogenic disorder, for example, as a result of stroke, craniocerebral injury, meningitis, or disease such as Parkinson’s disease and multiple sclerosis. Diseases of the muscles such as muscular atrophy (muscular dystrophy) or connective tissue such as scleroderma can also lead to swallowing problems.
- Tumors or surgery in the area of the neck, mouth and head, the cervical spine or the upper esophagus can also result in dysphagia.
- Poisoning, chemotherapy or radiation in the throat and esophageal area or a prolonged ventilator tube are other triggers.
- Especially in younger people are also psychogenic swallowing disorders – typical is the feeling of constantly having a lump in the throat, possibly coupled with a Räsuperzwang.
- In children, often underlying congenital malformations (eg, cleft lip and palate) or neurological diseases of the nervous system or muscles, not infrequently there is also a – comparatively banal – Vergörßerung of the palatine tonsils.
- In older people, the swallowing act is often less efficient overall – one also speaks of presbyphagia. The reaction time of the muscles and nerves is prolonged; tooth loss, reduced muscle strength, dry mucous membranes and ossification of the temporomandibular joint make swallowing even more difficult. In addition, in old age, frequent movement and coordination disorders, for example, as a concomitant of dementia.
Dysphagia: a vicious circle
Aspiration (entry) of food, fluid, or saliva into the airway can result in pneumonia or chest infection, which can ultimately mean death. Especially in the elderly, pneumonia is often due to dysphagia. If the swallowing process is disturbed, the eating process is often accompanied by coughing, throat clearing, gagging or drooling. This, in turn, causes the affected person to eat little or nothing at all. A vicious circle of continuous weight loss, malnutrition, dehydration (dehydration) and reduced quality of life is the result. The inadequate nutrition weakens the immune system, which significantly increases the age-related susceptibility to infections. As a result, the general condition deteriorates and diseases occur more frequently.
Dysphagia: diagnosis is important
If dysphagia is suspected, diagnostics by an appropriately trained physician are advisable in any case. This not only involves checking the extent of the dysphagia, but also looking for causes. In addition, the doctor can provide assistance for everyday life and refer to special specialists such as occupational therapists, speech therapists or nutritionists.
Nutrition tips for swallowing difficulties
Help with dysphagia can come from tasteless thickeners (special dietary foods). These can be used to quickly and easily bring cold and hot drinks as well as food to a consistency that makes swallowing easier. By pureeing the food, a homogeneous, pulpy food is achieved for low-risk swallowing. Foods such as potatoes and carrots are more suitable than fibrous vegetables such as leeks, asparagus or legumes. Foods such as noodle soup are completely unsuitable because two different consistencies are difficult to control in the oral cavity – thickened cream soup, on the other hand, works well.It is also advisable to serve meals with an acidic flavoring, such as lemon – this triggers the swallowing mechanism. The swallowing reflex can be trained and maintained with occupational therapy and speech therapy measures. Even and especially in the elderly, natural food intake with the help of drinking and eating aids (beakers, sliding spoons) is desirable for as long as possible and should be optimized with dietary measures such as thickeners, energy concentrates and sip feeds. High-calorie sip and tube feeds can also prevent malnutrition. It is important to eat while sitting, and at least 30 minutes should be spent sitting after the meal. If swallowing is no longer possible at all, other measures must be considered, such as feeding through a feeding tube.
