Choking threatens

Swallowing disorders: The silent danger

Swallowing disorders are particularly common in later life.

(Bild: wayhome.studio/stock.adobe.com)

As a young person, you hardly ever think about the fact that swallowing can be a complicated process. You just do it. As we get older, however, swallowing disorders become increasingly common. Where the dangers lie and which therapies can help.

We do it around 1000 times a day without even thinking about it: swallowing. Over the decades, however, this highly complicated process is prone to errors. This is known as dysphagia (swallowing disorder). Almost one in five older people suffers from it, and in care facilities it affects one in two!

"If oral bolus control is impaired [note: a bolus is a ball-like mixture of food and saliva that forms in the mouth when chewing], food, saliva or liquid can escape from the mouth again (drooling) or slide down the throat uncontrollably at an early stage without triggering the swallowing reflex (leaking)," says speech therapist Susanne Maria Javorszky, BSc MSc, Department of Health Sciences, FH Campus Wien, giving examples.

Aspiration is when bolus, liquid or saliva enters the airways. In this case, an efficient cough would help to expel the inhaled material.

Susanne Maria Javorszky, Logopädin

Bild: Susanne Maria Javorszky

"Aspiration is when bolus, fluid or saliva enters the airway. In this case, an efficient coughing thrust would help to expel inhaled material." Reduced sensitivity or a lack of coughing can sometimes lead to "silent aspiration".

Dangerous consequences of inhaled food
"In combination with a weakened immune system and bacterial colonization from the oral flora, such aspiration can be the trigger for aspiration pneumonia. This is an infection of the lungs caused by inhaling secretions from the mouth and/or stomach contents," explains Prim. Univ.-Prof. Dr. Bernhard Iglseder, Head of the University Clinic for Geriatrics, Christian Doppler Clinic, Salzburg University Hospital, in "Ärzte Krone". "However, the far more common consequence of dysphagia, which is associated with a number of complications, especially in older people, is malnutrition."

Swallowing is a complex process that requires precise coordination of 50 pairs of muscles and five pairs of cranial nerves.

(Bild: stock.adobe.com/Naeblys)

In the worst case, those affected can also choke if food "gets lost" in the airways. Rarely, "bolus death" occurs. This is a sudden cardiovascular arrest caused by a reflex triggered by a foreign body stuck in the throat and the associated pressure on the laryngeal nerve plexus.

Recognizing dysphagia
Doctors recognize dysphagia by coughing during food and liquid intake or by a wet, gurgling vocal sound afterwards. Those affected also report recurrent pneumonia, unintentional weight loss, malnutrition and muscle atrophy. Some also suffer from neurological diseases such as Parkinson's disease, multiple sclerosis and dementia.

Dysphagia screenings are well suited for an initial assessment. If these indicate the disease, a speech therapy swallowing examination provides further information. A definitive diagnosis is made by means of an apparatus-based procedure. Speech therapy exercises help to improve swallowing function. In addition, the patient can learn techniques to ensure safe food intake. Sometimes it is also necessary to avoid certain food consistencies (such as chewy).