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INTRODUCTION

The term dysphagia refers to any type of difficulty with moving food and/or liquid from the mouth to the stomach. A wide variety of conditions and circumstances can cause dysphagia. Speech/Language Pathologists (SLPs) typically receive specialized training in the diagnosis and treatment of oropharyngeal dysphagia. However, physicians working in both acute and subacute settings must be able to recognize the signs, symptoms, and possible causes of dysphagia in order to direct a plan of care that maximizes patient safety. This chapter will focus on the differences between normal and disordered swallowing and management of swallowing disorders, with an emphasis on oropharyngeal dysphagia.

EPIDEMIOLOGY

There is a lack of clear data regarding the prevalence of dysphagia in the general population; however, Bhattacharyya (2014) analyzed the 2012 National Health Interview Survey and found that in a single 12-month period, an estimated 9.44 million adults in the United States reported a swallowing problem, which correlates to 1 in 25 adults annually. The survey further revealed that approximately 31% of those with dysphagia reported it to be a moderate problem and approximately 25% of those with dysphagia felt that it was a very large problem. The average number of days that individuals reported being affected by dysphagia was 139 ± 7. While stroke was found to be the most common cause of dysphagia, other neurologic conditions and head and neck cancer were also common etiologies.

Dysphagia may occur at any point throughout the lifespan and it may result from a wide variety of circumstances from acute medical events, to diseases, to normal aging. Neurological events, conditions, and diseases that can be associated with dysphagia include but are not limited to stroke, traumatic brain injury, brain tumor, cerebral palsy, Parkinson’s disease, and amyotrophic lateral sclerosis. Many autoimmune diseases and conditions such as multiple sclerosis, myasthenia gravis, Guillain Barre Syndrome, and various forms of myositis may also be associated with dysphagia. Physical changes to the anatomy such as development of a Zenker’s diverticulum, cervical osteophyte, Schatzki ring, or damage to the vocal folds may result in dysphagia. Numerous surgical and/or medical interventions such as intubation, anterior cervical spine surgery, carotid endartarectomy, and resections for various forms of head and neck cancer may also be associated dysphagia. A variety of medications used to treat other conditions such as antipsychotics, antidepressants, anticonvulsants, and medications to treat anxiety may actually induce or worsen dysphagia. Finally, prolonged illnesses that require hospitalization may cause muscular deconditioning which may be correlated with the development of dysphagia.

Common, physical complications of dysphagia include, but are not limited to choking, dehydration, malnutrition, respiratory distress, and pneumonia. Additional, but often overlooked, complications of dysphagia are its social and psychological impacts. Since a great deal of the social occasions that people enjoy are centered around preparing and consuming food, individuals who are unable to swallow safely are often embarrassed by their swallowing problem and become ...

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