In the first instance you need to discuss eating and swallowing problems with your doctor and they will probably refer you to a speech and language therapist. As well as providing advice on speech and language problems, a speech and language therapist will be able to assess swallowing difficulties and give advice on ways to overcome or manage dysphagia. They may be able to:
- suggest exercises that will strengthen the muscles required for eating
- help reduce the risks of asphyxiation and aspiration
- provide ways to ensure that adequate food and liquid are consumed, including tips on the consistency and texture of food to make it easier to eat
- advise on techniques to help with eating.
You may also be referred to an occupational therapist who will advise on practical ways to make eating easier by making changes to the eating environment or providing special tools and equipment.
A dietician can also help by advising on the best types of food to eat and how to maintain good nutrition and a healthy weight. For more information see Diet & Nutrition.
If problems with eating and swallowing persist you may be referred for special tests such as:
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videofluoroscopy – the stages of swallow can be studied by eating food containing a radio opaque contrast, such as barium, which is then videoed by x-ray. This can pinpoint particular points at which swallow is problematic. The video x-ray may be repeated using different eating techniques, such as repositioning the head and neck, to establish which are most effective in overcoming a particular swallow problem.
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Fibreoptic Endoscopic Examination of Swallowing Safety (FEESS) – a small flexible tube with a light on the end can be passed into the back of the throat through the nose, allowing food and liquid to be studied as it passes through the throat. This can establish if the vocal cords are working, if the airways are protected and if swallow is efficient. Further examinations may be made by an Ear, Nose and Throat (ENT) specialist or a gastroenterologist.
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Laryngoscopy – a small flexible tube with a light on the end can be passed into the back of the throat so that the throat, larynx and tongue can be observed.
It is important to note these tests should be carried out whilst the head is still and in a particular position. They may therefore not be appropriate for some people and suitability should be discussed with your doctor.
In some situations, eating and swallowing may no longer be possible and an alternative feeding method will need to be used:
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nasogastric feeding - a tube is inserted through the nose and into the stomach and liquid foods are passed through it. This is generally used as a short term solution to a persistent problem.
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gastrostomy feeding - a small tube is inserted directly into the stomach and liquid foods are passed through it, sometimes with a dietary supplement to maintain the calorific and nutritional balance. The most common method of gastrostomy feeding is known as PEG (percutaneous endoscopic gastrostomy) and this is used as a longer term method of feeding. Gastrostomy feeding is beneficial in many ways: anxiety is reduced because eating the right food is no longer a worry; the risk of infection is reduced; energy levels should increase and quality of life and general wellbeing improve.
It may be possible for some small amounts of food to still be taken through the mouth but you should always consult your speech and language therapist before doing so. Once the wound has healed from insertion of the tube, normal bathing and swimming can be resumed.
Medications must of course still be taken when using alternative feeding methods although how they are taken will need to be adjusted. Your doctor will advise on the most suitable way - some may be injected and some may be fed in liquid or solution form through a tube.
