Swallowing is the process where food, liquid and saliva is moved from your mouth, down into your throat (pharynx), into the food pipe (oesophagus) and down to the stomach. The mouth and throat share the same pathway for breathing and talking so a swallowing reflex needs to occur to set a series of nerves and muscles into action to allow the upper airway to be closed off, by the epiglottis, to avoid food or fluid to go down "the wrong way" or into the airway.
Swallowing is complex and a number of conditions can interfere with this process. These can include; neurological deficits, structural abnormalities, autoimmune conditions, trauma to the head and neck, cancer or respiratory disease. The problems can occur in the mouth, such as problems chewing or liquid leaking into the nose, in the throat such a foods and tablets becoming stuck, or at the larynx where food and fluid can enter the airway (called aspiration) causing coughing, or choking. (Paul – add oesophageal / reflux issues too?)
It is very important that the swallowing process works efficiently so that food and fluid can move easily into the stomach to provide nutrition (and enjoyment!). Food or fluid entering the airway is unsafe can cause health problems such as aspiration pneumonia.
The MSAC team can provide direct evaluation of your individual swallowing symptoms and decide on the best course of treatment.
Instrumental swallowing examinations are often required to evaluate your swallowing problem in more detail. As the swallowing process occurs internally it often needs a closer look to see what is causing your symptoms.
The two most commonly used instrumental evaluations for oral and pharyngeal swallowing problems are a Functional Endoscopic Evaluation of Swallowing (FEES), which involves the use of endoscopy; and a Videofluoroscopic Swallowing Study (VFSS), which involves the use of radiography, or x-ray. They are both considered gold standard swallowing evaluations.
They both have their advantages however at MSAC we tend to use FEES initially to have a close up view of the pharyngeal and laryngeal structures during swallowing. This is a good way to evaluate any food or fluid residue in the throat and to see if the airway is closing off safely. If we have ongoing concerns or areas we want to look at in more detail, we will suggest further evaluation such as a VFSS.
At MSAC, initial appointments are for 30 minutes which should give us enough time to listen to your individual swallowing symptoms, take a detailed case history, look in your mouth and palpate your neck, as well as provide a full digital endoscopic evaluation of the your throat (pharynx) and voice box (larynx). In most cases you will be given a range of food and fluid consistencies to directly evaluate your swallowing compliant.
The Otolaryngologist and Speech Pathologist will bill separately for the service. The Otolaryngologist’s fee is partly refundable from Medicare. The Speech Pathologist’s fee is not refundable from Medicare but may be partly claimable from your health fund if you are privately insured. We will provide the fee schedule when you make an appointment enquiry and mail you the fee schedule with confirmation of your appointment.
Unless you are requested to do so, there is no need to fast for these procedures. After the examination, you may need to hold off eating for 30-60 minutes to allow the topical anaesthetic to wear off. This will be explained to you during your consultation.
Any examination via the nasal passage can provide a small level of discomfort. You are fully awake for this consultation and we can stop the evaluation at any time. If you prefer, the doctor can administer a small amount of topical anaesthetic to the nasal passages to reduce the discomfort.
Yes, speech pathologists and carers are encouraged to attend. This ensures the most accurate assessment of your swallowing problem, through additional history obtained from your own allied health specialist or loved one.
Once you have had a complete swallowing evaluation, the MSAC team can recommend ways to improve your ability to eat and drink depending on the specific problems found:
- Specific Treatments:
- If you have a focal muscular weakness or spasticity, this may be able to be treated with a procedure to improve closure or relaxation in your swallowing muscles – e.g. Vocal cord filler injection, Botulinum Toxin to tight swallowing muscles.
- In other cases, a surgical procedure may be recommended, which may be performed through the mouth (endoscopic) or through an incision in the neck (open).
- Swallowing Modifications:
- Strategies to improve swallowing safety. E.g. tucking chin down, turning head to side.
- Safe swallowing strategies such as eating slowly or taking smaller mouthfuls.
- Dietary Modifications
- Thickening drinks with special powders to make them easier toswallow.
- Softening your food to make it easier to chew and swallow.
- Swallowing Exercises:
- Specific exercises to improve your swallowing strength and coordination including Expiratory Muscle Strength Training (EMST), Chin Tuck against Resistance (CTAR) and effortful swallowing tasks.
Swallowing is complex and there is no "one size fits all" treatment solution. We will do our best to recommend a treatment program that will improve help you achieve the most efficient and safe swallowing function possible.
If you can’t swallow correctly then food and drink may be getting into your airway and lungs. This is called aspiration. If this happens it can lead to infections and pneumonia, which can be very serious. Swallowing problems can also lead to malnutrition. It is important that any changes to your swallowing are identified early, to avoid this happening.