Trouble with swallowing is both frightening and unpleasant, but help is available to make eating and drinking easier.
“When dysphagia — trouble swallowing — strikes, I can feel my adrenal glands kick in, my eyes widen, and a feeling of genuine panic for my life arise,” says Trevis Gleason, 55, a former chef who blogs for Everyday Health about life with multiple sclerosis (MS).
“I’ve even had to have someone perform the abdominal thrust maneuver when I went into a full choke,” he says.
While Gleason experiences swallowing issues only occasionally, dysphagia is a persistent and common problem — it’s estimated that more than one in three people with MS have trouble swallowing, according to a meta-analysis published in Neurological Sciences.
What Goes Wrong With Swallowing
Swallowing is a rapid coordinated multistep process involving the tongue, larynx, esophagus, and brain; considering this, it’s amazing that we don’t normally have to think about it.
“There are 17 components that work together during the two-second period in which swallowing occurs,” says Martin B. Brodsky, PhD, an associate professor and speech-language pathologist in the department of physical medicine and rehabilitation at Johns Hopkins University School of Medicine in Baltimore.
Of the 12 cranial nerves in the brain, Dr. Brodsky says, half are devoted to swallowing, and these 6 cranial nerves control upward of 30 pairs of muscles.
In a properly executed swallow, the airway is closed tightly before the swallow is initiated and food or liquid enters the throat. Once the swallow is complete, and the food or beverage is gone, the airway opens back up.
Swallowing issues related to multiple sclerosis are usually due to problems in the timing, or coordination, of a swallow or to weakness in the muscles used to swallow.
Faulty timing When the timing of a swallow is off, food or liquid in the mouth drips down into the throat before the swallow is initiated and the airway is closed off.
“Because you haven’t initiated the swallow in a timely manner,” Brodsky says, “you now have the opportunity for the food to drop into the airway, and you can have coughing or choking before the swallow begins.”
Weak swallowing muscles When the muscles involved in swallowing are weak, the swallow may be initiated properly and the airway may close, so it’s protected, but not all the food or liquid goes down. That means that when the swallow is complete and the airway opens back up, a residue of leftover food and drink is left in the throat.
“This is the reason most patients with MS have problems,” says Brodsky. “Over time, that residue builds up, and eventually there may be a tipping point. The areas within the throat that are capable of keeping the person safe under most circumstances are filled.”
When food or liquid enters the airway, it’s called aspiration. If the person cannot cough out the material that was breathed in, it can lead to a potentially life-threatening lung infection known as aspiration pneumonia. In fact, aspiration pneumonia is one of the leading causes of death in MS (although swallowing problems are just one of many risk factors for developing it).
Click here to continue reading the important sub-heading titles showing below
- Risk Factors for Dysphagia…
- How Dysphagia Is Diagnosed…
- A Combination of Approaches Can Help Improve Swallowing in People With MS
- Posture Changes May Help Control the Flow of Liquids and Foods
- Techniques Designed to Keep Airway Closed May Improve Swallowing
- and more
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