Dysphagia: When a person has 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.

"In the case of a chest infection, as our airway and food pipe are just next to each other, dysphagia (difficulty swallowing) 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," explained speech therapists from the Speech Therapy Department at Singapore General Hospital (SGH), a member of the SingHealth group.

Here are some useful tips to cope with swallowing difficulties.

4 Tips to cope with dysphagia (difficulty swallowing)

1. Maintain good oral hygiene

• Research has shown that good oral hygiene reduces the chance of developing lung infection.
  Caution: For some people with difficulty swallowing, gargling might pose a risk of liquids entering the airway. An alternative to gargling would be using a damp towel or gauze to clean the interior of the mouth.

2. Adjust mealtimes, environment and setting

• Sit upright during mealtimes. If possible, sit on a chair instead of staying in bed during mealtimes.
  

• Feed only when alert.
  

• Reduce distractions during mealtimes.

3. Adopt safe eating habits

• Do not talk with food/liquids in mouth.

• Clear food/liquids in mouth before taking the next mouthful. To remind the person with difficulty swallowing to clear any leftover food/liquids, caregivers may verbally ask the person to swallow, or put an empty spoon into the person’s mouth.

4. Modify the diet

• Drink from a spoon of appropriate size instead of drinking from the cup. Put the whole spoon into the mouth instead of slurping from the spoon.

• Straw-drinking may not be recommended for people with dysphagia as it requires more coordination than cup-drinking.

• Add thickener to liquids if recommended by your speech therapist. Thickened liquids flow slower, allowing more time for the control of the liquid. Caution: Thicker liquids are not always better. A speech therapist will be able to advise you on the appropriate texture.

• Eat food that is softer or cut in smaller pieces. Blend if necessary.
  

• Avoid taking solid and liquid in one single spoonful (e.g. noodle soup). This requires more coordination since solid and liquid travel at different speeds, and may not be suitable for people with difficulty swallowing.

• If finishing a meal is tiring, try small, frequent meals.
  

Watch this video for more tips to manage dysphagia (difficulty swallowing).

Signs of dysphagia (difficulty swallowing)

Here are some signs to look out for to know if a person has dysphagia:

• Frequent coughing or throat clearing when you eat/drink

• Taking too long for each meal (e.g. more than an hour)

• Difficulty swallowing your own saliva

• Drooling at rest or during mealtimes

• Avoidance of some food or liquids

• Holding of food or liquids in the mouth for a prolonged duration

• Feeling tired and/or breathless during or after meals

• Unexplained weight loss

What causes dysphagia (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: