Swallowing Problems: Do You Have Them?
Swallowing problems (Dysphagia) in polio survivors can be caused by two or more disorders:
Muscle weakness in either the tongue or throat muscles – which can be due to prior polio damage or new problems such as a stroke affecting those muscles.
Problems in the Esophagus -
Narrowing of the tube due to scarring from acid reflux or poor coordination of the muscles
Presbyesophagus - related to aging,
Some deformity of the esophagus itself - such as masses, out pouches (diverticulum), or even pressure from large bone spurs from severe arthritis in the neck.
The best diagnostic test I’ve seen is a modified barium swallow study (MBSS) that is done by a speech therapist/swallowing expert along with a radiologist, usually done as an outpatient at a hospital. It involves the patient swallowing barium in a thin liquid (consistency of water) and a thicker solution (milkshake consistency) and finally, something that resembles solid food (such as crushed Oreo cookies or marshmallows). During the test, the speech therapist concentrates on how the muscles in the mouth and back of the throat are working and the radiologist concentrates mostly on the function of the esophagus.
Note: An endoscopy looks at the appearance of the esophagus and stomach but does not look at how it functions during swallowing.
The speech therapist not only determines the malfunction of the swallowing muscles but can also offer advice and treatment about how to deal with a person’s specific problem.
For a person with neuromuscular swallowing problems, although it does not seem to make sense, thin liquids (like water, apple juice) and dry foods (bread, crackers) are usually the most difficult to swallow and most likely to cause coughing/choking. Thicker liquids (nectars like apricot nectar, puddings, milkshakes/smoothies) are easier to swallow than water, coffee or tea.
Thickening agents {some brand names are Thick-It or Simply Thick} can be added to thin liquids to make them easier to swallow. It is also important to follow bites of food with frequent sips of a liquid and to cut solids such as meat in small bites and chew thoroughly before swallowing.
(Originally published by Easter Seals Colorado, Spring, 2021)