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Unidentified Causes of Dysphagia


Dysphagia can be exhibited in many ways: coughing, choking, feeling like food is sticking, difficulty or pain with swallowing, bringing food back up, and others.  Sometimes the dysphagia is accompanied by, or can cause, changes in overall health, like weight loss or changes in lung health.    Sometimes the cause of these dysphagia symptoms is obvious, such as when a person has a neurological disease (e.g. Parkinson’s, dementia), has experienced a traumatic episode (e.g. stroke, head injury), or has head and neck cancer.

However, sometimes the symptoms of dysphagia cannot easily be tied to an obvious cause, and therefore no treatment plan can be developed. When that happens, it can be very frustrating and you may feel abandoned by the medical team. What steps can you take if you find yourself in that situation?

  1. Do some research on your own on the web to see if there is any information about swallowing symptoms similar to yours.  Be sure you are reviewing information on reputable sites, such as the Mayo Clinic,, WebMD, etc.  
    • Take good notes on what you read and list the site(s) where you found the information.
  2. Make note of anything you do, or any circumstances, that make the problem better or worse.
    • Better or worse at certain times of the day or night?
    • Relieved or made worse when eating or drinking certain foods?
    • Better or worse when sitting, standing or lying down?
  3. Meet with a member of your medical team, share all of this information,  and pose a series of questions:
    • Review all of your medications (prescription and over-the-counter) with the medical professional and ask if any of those medications might be contributing to your symptoms.
    • Be sure the medical professional is aware of any other medical problems you are having, or have had in the past. Some of these problems might not seem obviously related to your current symptoms, but relationships like that aren’t always clear. For example:
      • ‘Indigestion’ might not seem related to a feeling of a lump in the throat, but the indigestion might be reflux and that feeling of a lump in the throat is likely related.
      • Feeling strain when talking or having a persistent cough might not seem related to pain with swallowing, but it could be.
    • Are there any other diagnostic tests that are indicated to gain more insight into the problem?
    • What are those tests and what further information might be gained?
    • Has the medical professional ever seen another person who presents with symptoms similar to yours?
    • Is there another medical professional you should consult?
    • If you are very anxious about your problem, discuss how anxiety can make certain symptoms worse.
  4. Seek out an assessment at a multi-disciplinary swallowing center. This might be called a Swallowing Center, Swallowing Clinic, Voice and Swallowing Center or Dysphagia Center. Because dysphagia symptoms may seem like they are occurring in one part of the body, but actually originate in another, a multi-disciplinary team that can be found at these centers is often indicated to take a holistic look at the presenting problem.  These specialized centers are usually affiliated with large university systems and would ideally include professionals from specialties such as:
    • Neurology
    • Gastroenterology
    • Otorhinolaryngology
    • Speech-Language Pathology (one with Board Certification in Swallowing). You can check the website of the American Board of Swallowing and Swallowing Disorders to find such a professional:

If you need any assistance finding a specialist, you can reach out to the NFOSD at Our medical advisory board can help provide referral information for the most appropriate specialist.

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Feeding the Medically Fragile Infant

Written by Rebecca Brown, M.S., CCC-SLP, CNT 

Amy’s Story

Amy was born at 24 weeks gestational age, 16 weeks before her due date. Amy was born with her twin, but her sister did not live more than twenty-four hours after delivery. Since delivery, Amy has undergone multiple procedures, including x-rays, eye exams, head ultrasounds, and phototherapy. She was on mechanical ventilation because of her immature lungs for more than a month before being able to breathe without the assistance of the ventilator.  Amy still required supplemental oxygen through a nasal cannula in order to support her breathing. At 32 weeks, Amy began demonstrating signs of hunger, including bringing hands to mouth, opening her mouth wide, and moving her head around to search for a breast or bottle. How should the medical team approach feeding this medically fragile infant?

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Radiation Associated Dysphagia

I didn’t have trouble swallowing right after my radiation treatment, so why now, years later?

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Dysphagia & Patients with Tracheostomy and Mechanical Ventilation

What is a tracheostomy?

A tracheotomy is a procedure where an opening is created in the neck and into the airway (trachea) and a tracheostomy is the resulting stoma (hole) that is created.  A tracheostomy tube is typically placed into the stoma to allow for direct access to the trachea for breathing and removing secretions from the airway and lungs.  The tube enables air to flow directly through the trachea rather than through the nose and mouth, bypassing the upper airway.

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Swallowing and Parkinson’s Disease

Quick Facts:

  • Swallowing difficulty can occur at any stage of Parkinson disease (PD), even the early stages
  • The leading cause of death in PD is aspiration pneumonia due to swallowing disorders.
  • Evaluation and treatment of swallowing disorders are performed by a speech language pathologist
  • Swallowing disorders are treatable

Difficulty swallowing, or dysphagia, can happen at any stage of Parkinson disease and can be localized to the mouth, throat, and esophagus. Signs and symptoms can range from mild to severe and may include:

  • Drooling
  • Difficulty swallowing certain foods or liquids
  • Coughing or throat clearing during or after eating/drinking
  • Needing to swallowing multiple times per bite or sip
  • Feeling as if food is getting stuck
  • Frequent heartburn/reflux

As the disease progresses, swallowing can become severely compromised and food/liquid can get into the lungs, causing aspiration pneumonia. Aspiration pneumonia is the leading cause of death in Parkinson’s. There is also a risk for severe choking, when food lodges in the airway and prevents the ability to breathe.

It is important to take note of any changes to swallowing function, because there is opportunity to intervene early and preserve both health and quality of life. Swallowing disorders are managed by the medical team with a speech-language pathologist and physician. Evaluation typically involves an interview, a physical examination of the head and neck, trials with food/liquid and if indicated, an instrumented examination, either with a moving x-ray, called videofluoroscopy (also known as a modified barium swallow study) or by visualizing the throat with a scope (called endoscopy). New technologies are being developed that may be able to detect Parkinson’s-related changes to swallowing function even before someone begins to notice swallowing difficulty. One example is high-resolution manometry, a technique that measures pressures generated in the throat during swallowing (see figure below).

Images from a videofluoroscopic (x-ray) swallow study (left) and high-resolution manometry (swallowing pressures) study (right) from a healthy individual (top) and a person with Parkinson disease (bottom). In the person with PD, note airway invasion of the swallowed contrast (white arrow), reduced opening of the upper esophagus (black arrow), and need for multiple swallows (magenta arrow).

Treatment of swallowing disorders is specific to the nature of the swallowing problem, but can involve strategies to help food or liquid go down safely (swallowing hard, holding your breath while swallowing, tucking the chin while swallowing), diet changes (thickening liquids, making foods softer), exercises, or a combination of these. In some cases, alternatives to oral feeding, such as a feeding tube, are indicated. However, just because you have a swallowing problem, it does not mean that you will need a feeding tube.

Because Parkinson disease is progressive, swallowing abilities can change over time, underscoring the need for early intervention and frequent follow-up. It may be beneficial for you and your healthcare team to have a “baseline” swallowing study as a comparison for later in the disease progression. Sometimes the signs of a swallowing disorder can be subtle, so it is important to be vigilant. Below are some signs that you may have a swallowing problem:

  • You have recently lost weight without trying
  • You tend to avoid drinking liquids
  • You have heartburn or a sore throat
  • You tend to drool
  • You get the sensation of food stuck in your throat
  • You cough, choke, or clear your throat during or after meals
  • You have trouble keeping food or liquid in your mouth
  • You have trouble moving food to the back of your mouth
  • You have difficulty swallowing pills
  • You have lost your appetite
  • It takes you a long time to eat a meal
  • Sometimes you have a fever for no apparent reason

If you think you have difficulty swallowing, ask your physician to refer you to a speech-language pathologist for a swallowing evaluation.  

References and Resources:

  • Beyer, et al. Causes of death in a community-based study of Parkinson’s disease. Acta Neurol Scand. 2001;103(1):7-11. PubMed link
  • Ciucci, et al. Early identification and treatment of communication and swallowing deficits in Parkinson disease. Semin Speech Lang. 2013;34(3):185-202. PubMed link
  • D’Amelio et al. Long-term survival of Parkinson’s disease: A population-based study. J Neurol. 2006;253(1):33-7. PubMed link
  • Jones & Ciuicci. Multimodal swallowing evaluation with high-resolution manometry reveals subtle swallowing changes in early and mid-stage Parkinson disease. J Parkinsons Dis. 2016;6(1):197-208. PubMed link
  • Michou & Hamdy. Dysphagia in Parkinson’s disease: A therapeutic challenge? Expert Review of Neurotherapeutics. 2010;10:875-8. PubMed link
  • Pflug, et al. Critical dysphagia is common in Parkinson disease and occurs even in early stages: A prospective cohort study. Dysphagia. 2018; 33(1):41-50. PubMed link
  • Plowman-Prine, et al. The relationship between quality of life and swallowing in Parkinson’s disease. Mov Disord. 2009;24:1352-1358. PubMed link