What Is a Normal Swallow?

Normal swallowing is the complex act of moving food, drink, or saliva from the mouth to the stomach. Normal swallows should be safe, efficient, and usually satisfying. Swallowing can be divided into three stages: oral, pharyngeal, and esophageal.

Oral Stage

The parts of the mouth, including the tongue, teeth, and lips work together to chew and mix food or drink with saliva. This mixture creates a soft ball of food called a bolus. The tongue, cheeks, and lips also work together to push the bolus to the back of the throat.

Pharyngeal (top part of the throat) Stage

The bolus is moved through the throat (pharynx). At the same time, the entrance to the airway closes during swallowing, preventing the entrance of material (food, liquid, or saliva) into the airway and lungs. The bolus is then directed into the top part of the food tube (esophagus).

Esophageal Stage

The bolus moves through the esophagus into the stomach.

What Is Dysphagia?

Dysphagia means swallowing problem. Dysphagia occurs when there is a problem in any stage of moving food, liquid, or saliva from the mouth to the stomach. Dysphagia can make swallowing unsafe, may be painful, and can put a person at risk for malnutrition, dehydration, fatal choking episodes, and pneumonia.

Dysphagia can also make swallowing inefficient, requiring extra time to eat. It can make eating unpleasant because of the fear of choking or of growing tired of dietary restrictions.

Symptoms of Dysphagia

Oral symptoms include:

• Food spilling from the mouth
• Food remaining in the mouth after swallowing
• Difficulty chewing
• Poor control of food and liquid in the mouth
• Trouble forming food and liquid into a soft ball in the mouth (bolus)
• Needing extra time to chew or move food or liquid in the mouth
• Trouble pushing food or liquid to the back of the mouth (discoordinated, too fast, too slow)

Pharyngeal symptoms include:

• Food or liquid entering the airway when swallowing
• Coughing
• Throat clearing
• Choking
• Sticking sensation in the throat after a swallow (residue)

Esophageal symptoms include:

• Trouble with food entering the esophagus (food tube)
• Feeling food stick in the throat or chest after a swallow
• Regurgitating food -- digested or undigested food coming back up into the throat or mouth after a swallow
• Reflux

Causes of Dysphagia

There are many different causes of dysphagia. Congenital causes of dysphagia refer to swallowing problems that begin at birth. For example, cleft lip and palate occur at birth and can cause problems with feeding and swallowing.

Another cause of dysphagia can be structural problems or changes to the form of the mouth, throat, or esophagus. If a person has tongue cancer and part of the tongue is removed surgically to treat the cancer, this can cause dysphagia.

Finally, neurological damage can cause dysphagia. This includes any disease or disorder that causes the muscles or nerves that control swallowing to be weak, slow, uncoordinated, or have changed sensation. A person who had a stroke may have imparied sensation to their mouth and throat, have weakness on one side of the mouth and throat, and have discoordinated swallow movements.

Diagnoses Associated with Swallowing Disorders

Conditions that frequently result in dysphagia include:

• Stroke
• Parkinson's disease
• Amyotrophic lateral sclerosis (ALS)
• Traumatic brain injury
• Pediatric cardiac deficits
• Pompe disease
• Cleft lip and palate

Complications of Dysphagia

• Penetration/aspiration
• Pneumonia
• Weight loss
• Increased meal times
• Lack of enjoyment with eating and drinking
• Avoidance of eating in public