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Speech and Language and…. Swallowing?

November 12, 2011

Eating is not merely a material pleasure. Eating well gives a spectacular joy to life and contributes immensely to goodwill and happy companionship. It is of great importance to the morale.

Elsa Schiaparelli

Swallowing Disoders

It’s not surprising to hear that eating is a great pleasure for most of us. What is surprising is that many people suffer from swallowing disorders that can ultimately reduce the joy of eating. Dysphagia is a symptom of swallowing difficulty that can occur following a stroke  or other neurological disorder such as Amyotrophic Lateral Sclerosis (ALS). Dysphagia  can lead to aspiration pneumonia (i.e., pneumonia caused by food entering the lungs), choking, and malnutrition. Also, because patients with dysphagia often experience difficulty with bolus (i.e., chewed food) control and drooling they often remove themselves from social eating situations and therefore face social isolation.

Swallowing disorders also encompass disorders of the esophagus such as gastroesophageal reflux disease (GERD). GERD arises when acid from the stomach enters the esophagus. This poses a risk of aspiration for patients with dysphagia because the acid of the stomach can wash up the esophagus and into the larynx and lungs resulting in aspiration. The acid wash can also affect non-dysphagic patients by damaging the vocal folds and causing a hoarse voice or voice disorder.

Swallowing and the SLP

The speech language pathologist plays a central role in the evaluation and treatment of swallowing disorders. For mild cases of dysphagia, intervention may include the recommendation of a modified diet to foods that are easier to swallow such as thickened liquids. Patients with a more severe risk of choking or aspiration may be placed on a no food by mouth diet (i.e., also referred to as NPO) and would receive their nutrition through a gastric tube. For issues surrounding GERD and voice, the SLP may provide education around ways to reduce GERD, such as altering diet or sleeping at an angle. And as always the SLP is also concerned with ways to optimize opportunities for communication.  The SLP may then recommend modifications to seating arrangements during mealtimes and other events to help keep people engaged in social opportunities while protecting their voice from further harm.

A student’s first hand experience with a swallowing study

As a SLP student I have an interest in all things speech, language and swallowing. So when I was offered the opportunity to participate in a University of Alberta study looking at swallowing, I jumped at the chance! The study in question was looking at a new way to image the  esophagus and involved insertion of a tube through the nose and down to the level of the lower esophageal sphincter (i.e., where the esophagus meets the stomach). Before insertion of the tube and imaging device I first had to sniff up a gel like substance to numb my nasopharnx and pharynx. This made insertion of the imaging device less uncomfortable but it tasted very bitter! Once the imaging device was in place I was then instructed to swallow several times as the device recorded the action of the lower esophageal sphincter (LES). The video below is a short clip of my LES before a swallow. The LES is the dark ring. Enjoy!

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