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Wednesday, December 07, 2022

dysphagia, an underdiagnosed disorder that makes swallowing difficult

difficulty swallowing It is defined as difficulty in swallowing both solid and liquid food from mouth to stomach. It is more than a disorder in itself, the result of many disorders and diseases. Its symptoms can lead to severe difficulties such as malnutrition and dehydration, as well as pneumonia and respiratory infections.

There are two types, oropharyngeal and esophageal dysphagia. The first of these is the one that originates in the pharyngeal region, making it difficult for food to pass through. This, on the other hand, allows these foods to move beyond the pharynx, presenting complications once they move down the esophagus. Both malformations are diagnosed and treatedExperts condemn.

is a type of oropharyngeal dysphagia that concerns speech therapy professionals, because The consequences endanger the lives of patients who suffer from it, “If there are changes in the protection of swallowing, suffocation can occur which can lead to respiratory infections, pneumonia and even death. Meanwhile, if there are changes in efficiency when swallowing, it leads to malnutrition and dehydration,” explains Carmen Cioli, deputy dean of the Official College of Speech Therapists in Andalusia.

This specialist in dysphagia condemns that it is still underdiagnosed disorder, Dysphagia became more relevant as a result of the COVID-19 pandemic, as intubation and tracheotomy triggered the number of cases in hospitalized patients. About 40% of recently evacuated patients, and between 50% and 84% of those who require a tracheostomy, have difficulty swallowing food afterwards.

However, the prevalence of this type of disorder was already high before the coronavirus outbreak: “It is estimated that dysphagia affects more than two million people across the country, with 10% of them being diagnosed”Cioli warns. In the oropharynx, its causes can range from diseases that directly affect the pharynx, such as pharyngitis or tonsillitis, to neurological conditions such as Parkinson’s, lateral amyotrophic disease (ALS), multiple sclerosis, Alzheimer’s …; Head injury and stroke or tumors in the head or neck area.

Once the causes that cause this difficulty swallowing are known, it is necessary to establish an assessment of the patient’s degree of dysphagia. “It is essential to give this importance, at the time of evaluation, to identify the degree of dysphagia to know the swallowing disorders and to design an individualized and effective therapeutic plan for each patient”, points out this professional.

The main objective of the speech therapist is to ensure the safest and most efficient ingestion possible, which allows to maintain the patient’s state of optimal nutrition and hydration. There are different types of speech therapy, explains Carmen Cioli, which will depend on the specific case: «An indirect therapy, which is done with patients who have problems with all immobilities; There is a direct stimulation therapy, which works on activation of the swallowing reflex, and a direct swallowing therapy, which works on postural techniques on food and adaptation to food consistency».

Here thickeners come in handy – an ingredient added to liquids to increase their consistency – and different textures that must be adapted based on the patient’s degree of dysphagia to avoid choking. In the most severe cases, in which safe and effective feeding cannot be guaranteed, “options should be considered to maintain the supply of nutrients and hydration, such as parenteral nutrition – through the vein of nutrients.” Administration of – or surgery”.

mental health

When dysphagia is not treated properly, its consequences lead to “deterioration in patients’ quality of life”. Difficulty swallowing directly affects all areas of life as we know it, because “food is not just a matter of survival, it is a social act of pleasure for many.”

It is at this point that the mental health of these people is compromised. “Another consequence of dysphagia is depression. The fact that these patients see their diet as limited means that other day-to-day issues are limited, such as family gatherings or eating out with friends or for pleasure,” says Carmen. Cioli explains.

This professional assures that many patients “stop going to restaurants or socializing. They are isolating themselves and leaving these relationships and this indulgence.” In this sense, Cioli recalls that “we must take into account not only the important part, but also the emotional and social part of suffering from dysphagia.”

Warning signs and symptoms to identify swallowing problems

One of the main reasons that complicates the early diagnosis of dysphagia is the difficulty in recognizing its symptoms, as some of them may be very general and may not bother the patient.

Even then, The warning signs to identify a swallowing problem are obvious. These include clearing the throat during or after coughing or swallowing; choking; a feeling of suffocation before or after swallowing; Voice changes after swallowing; Difficulty progressing to meals; Multiple swallows are required to be able to swallow a single bolus; the presence of oral residues after swallowing; long feeding time; change in eating habits; salivation; unintentional weight loss; Difficulty and effort in eating that assumes distaste or refusal or a respiratory infection.

They also condemn the Official Association of Speech Therapists of Andalusia that The underdiagnosis and treatment of dysphagia is also due to a “lack of knowledge of the functions of the speech therapist”.as well as the efficacy of their treatment.

In this sense, Carmen Cioli condemns the lack of speech therapists in health, the lack of pioneering projects related to dysphagia, and the lack of procedures to care for patients with acute dysphagia. Thus one of the demands of this college is that “we are more present at the hospital level, we are lacking in many areas and this is one of the most important”.

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