Dysphagia: when you have difficulty swallowing

Frequent coughing when eating or drinking is not normal, and could indicate dysphagia, a medical term for swallowing difficulties. Such difficulty swallowing may lead to chest infection, dehydration or malnutrition, which are potentially fatal conditions.

What is swallowing?

Swallowing is the process of moving food or liquid from one’s mouth to the stomach. It is something we do almost automatically, but is in fact a complicated process involving many muscles and nerves.

Swallowing is done in three phases: oral phase (within the mouth), pharyngeal phase (through the throat) and oesophageal phase (through the food pipe before reaching the stomach). Swallowing difficulties may be encountered along any of these phases, and could occur with liquids and/or solids.

Why do some people have difficulty swallowing?

Swallowing difficulty is not a primary condition. It is usually a consequence or side effect of a medical condition or treatment. Swallowing requires intact sensation and adequate muscle strength. People who suffer from medical conditions or who have undergone treatment affecting the nerves and/or muscles involved in the swallowing process may experience swallowing difficulties. An obstruct​ion along the swallowing tract, such as a tumour, could also result in difficulty swallowing.

Here are some risk factors for swallowing difficulties:

• History of stroke or brain injury
• History of radiotherapy to the head and neck region
• History of surgery to the head and neck region
• Existing medical conditions like Parkinson disease, myasthenia gravis, dementia

How can dysphagia lead to chest ​infection?

As our airway and food pipe are just next to each other, dysphagia can result in food and liquids entering the wrong way, into the airway, and into the lungs. This can potentially contribute to aspiration pneumonia – a chest infection due to the entry of foreign material into the lungs.

Who can diagnose dysphagia?

A speech therapist diagnoses swallowing difficulties related to the oral and pharyngeal phases, whereas swallowing difficulties related to the oesophageal phase are diagnosed by a doctor.

Here are some signs of swallowing difficulties:

1. Frequent coughing or throat clearing when you eat/drink
2. Taking too long for each meal (e.g. more than an hour)
3. Difficulty swallowing your own saliva
4. Drooling at rest or during mealtimes
5. Avoidance of some food or liquids
6. Holding of food or liquids in the mouth for a prolonged duration
7. Feeling tired and/or breathless during or after meals
8. Unexplained weight loss

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Ref: S13