Dysphagia (swallowing disorder)

Swallow easily again

An adult human swallows up to a thousand times a day – much more frequently during eating than, for example, during deep sleep. The swallowing process involves the cheeks, lips, jaw, tongue, soft palate, pharynx, larynx, hyoid bone and oesophagus. More than 100 muscles ensure a smooth swallowing process. If a component is disturbed, the course of the swallowing act may collapse.

At Schoen Clinic, we specialise in swallowing disorders (dysphagia). Our experienced consultants and therapists provide you with effective therapies to control your dysphagia.

Causes & symptoms

What is dysphagia?

Dysphagia is the inability to reliably transport saliva, fluids or food from the mouth to the stomach. 

The entire swallowing process can be divided into three phases: 
  • Oral swallowing phase
    If there is a disorder here, the intake or grinding of food in the mouth is already impaired. An insufficient or missing chewing process, disturbed tongue strength or mobility, or a sensory disturbance can disrupt the oral swallowing phase
  • Pharyngeal swallowing phase.
    In the event of a disorder, the ingested food or fluid cannot be transported unhindered through the throat into the oesophagus.
  • Oesophageal swallowing phase
    If a disorder in the oesophageal phase is the cause of dysphagia, the transporting of food through the oesophagus to the stomach is hindered.

Causes: How does dysphagia develop?

Dysphagia can occur after many neurological diseases. 

The most frequent causes are: 
  • Stroke
  • Traumatic brain injury
  • Inflammatory diseases of the nervous system (e.g. multiple sclerosis)
  • Degenerative diseases of the nervous system (e.g. Parkinson’s disease)
  • Tumours in the brain

Diseases of the peripheral nerves with the involvement of the cranial nerves and muscle diseases can also trigger a swallowing disorder. Tumour operations and radiation in the head and neck area often lead to dysphagia.

Symptoms: Indications of dysphagia

The following symptoms indicate dysphagia:
  • Feeling of pressure or lumps in the throat
  • Food or liquids getting stuck in the throat
  • Choking fits or coughing after eating / drinkin
  • “Moist” or gurgling voice after swallowing
  • Saliva leaking from the mouth
  • Chewing disorders
  • Reduced strength and reduction of the tongue musculature with muscle twitches
  • Reduced mobility of the tongue
  • Lack of a gag reflex
  • Missing or insufficient, arbitrary lifting of the soft palate with normal or increased palatal reflex
  • Disturbed sensory perception in the mouth and throat area
  • Vocal fold paralysis or hoarseness, voice disorder, loss of voice
  • Speech disorder
  • Only small amounts of food and/or drink can be consumed.
  • Changed posture when swallowing (e.g. forward inclination of the head)
  • Unclear fever episodes, acute or recurrent pneumonia

Swallowing disorders often lead to considerable restrictions on quality of life. Possible consequences include malnutrition, dehydration (lack of water), pneumonia or dependence on artificial nutrition.

Diagnostics

Diagnosis: This is how dysphagia is detected

Depending on the symptoms, we examine at Schoen Clinic
  • whether you actually have a swallowing disorder
  • how serious it is
  • which specific processes are disturbed
  • what the cause of your dysphagia is

In many cases, dysphagia can be diagnosed by a neurological and logopaedic examination, special instrumental diagnostics (endoscopy, magnetic resonance imaging, computed tomography) as well as a detailed conversation about your illness and illnesses that have occurred in your family. 

Neurological examinations

The various diseases that can cause dysphagia are contrasted by numerous examination methods. Magnetic resonance imaging of the skull is performed in order to rule out multiple sclerosis or tumours at the base of the skull, for example.

There are two important methods to determine the cause, type and severity of your dysphagia: 
  • Flexible endoscopic evaluation of swallowing (FEES)/tracheoscopy
    During this, a thin, flexible endoscope is inserted through your nose or tracheal cannula. This allows us to directly observe the processes before and after swallowing. 
  • Video fluoroscopy
    This examination method enables a diagnostic classification when fast motion sequences in the chewing and swallowing process need to be shown. For the examination, you swallow a special contrast agent that the doctor can use to assess the function of the swallowing process

These examination procedures are also required in order to prepare a treatment plan and for follow-up.