Best Ways to Diagnose and Treat Dysphagia

 “The focus of meal time is not simply about getting a job done but, rather experiencing a meal.”  This is what exactly happens in patients with dysphagia and it really affects them mentally…..

What does dysphagia exactly mean ? It means inability to eat or swallow ! June is dysphagia awareness month and so the whole effort to make you aware how difficult it is to live with this issue, to give you an overview about dysphagia.

Once I had a young patient coming to my clinic with difficulty in swallowing and that’s when I decided to really do something for these patients. It was like a mission to learn everything about dysphagia and treat it, the main aim being make the patients suffering from dysphagia comfortable !! Can you imagine yourself having problem swallowing ,a process we take for granted !? Do you connect with this ? These patients get distressed because they are not satiated as, they are not eating normally, there is no experience of chewing or swallowing ! The sense of taste is absent.

Again a story of a young patient coming to my clinic with a feeding tube going through his nose for Nutrition, as he was unable to swallow !! He had suffered from a stroke one month ago after which he had developed dysphagia. Recovered completely from stroke, except this one thing called swallowing !! He used to cough every time he had something to drink or eat, he had a voice which was very gurgly. This was really distressing to see ….we diagnosed the problem with the help of FEES and DSS. He had developed Cricopharyngeal spasm post medullary stroke and was treated completely with Injection Botox in the cricopharyngeal muscle !!  We repeated a Dynamic Swallow Study after 10 days , to check his swallowing and voila he was good to eat orally ! It was such a happy moment for the patient as well as us as a team….

So ,what are the symptoms of dysphagia ?

Coughing when swallowing

Gurgly/wet voice

Inability to propel food

Choking on food

Food getting stuck in the throat

Weight loss

Loss of appetite

Another thing to keep in mind is , 

Suffering from Diabetes, Myasthenia gravis , Parkinson’s disease , stroke , any surgery or any other neurological disorders, Cancer Surgery, Radiation therapy etc…..And if you are suffering from any of the above , you have to contact a laryngologist or a doctor specialized in swallowing disorders !!

The next obvious question is why and what will the laryngologists do ?? Oh yes, it’s a million dollar question !! “Dysphagia is more than not able to eat !!” When suffering from dysphagia , you don’t enjoy your meal!! So how exactly is it diagnosed ?? We as laryngologists have to find out exactly what is the reason for the problem, in every particular case !

FEES ; Functional endoscopic evaluation of swallowing 

DSS; Dynamic Swallowing Study

Esophagram

TNE; Trans-Nasal Esophagoscopy 

All these tests either individually or in combination help us in diagnosing the problem or basically get to the root of the issue ,and we can chalk out a plan for treatment ,which could be swallowing therapy , surgery or interventional procedure! Laryngologists and swallowing therapists are part of the team for treating dysphagia. It’s the team work that pays off !!

Management of dysphagia depends on the diagnosis. As explained earlier it could be swallowing therapy, surgery or interventional procedures ! Swallowing therapy forms an important part of the treatment of swallowing right from bedside evaluation to therapy post surgery or procedures or just therapy as the first line of management. 

We had once seen a patient with difficulty in swallowing. Only complaint in her case was difficulty in swallowing for 4 to 5 years. She has no weight loss, no comorbidities, no other complaints at all. She had visited multiple doctors ,but with no diagnosis !!  She was also labelled as psychosomatic . As it is said, “Eyes don’t see what the mind doesn’t know”, the diagnosis was not made . She as an individual was really exhausted with the issue and wanted a solution…. We were able to diagnose and treat her surgically !So can you imagine, an otherwise healthy individual is not able to eat what she wants to , it is really horrifying isn’t it?? When you are able to treat these patients and when you see them swallowing it is really heartwarming and gratifying !! 

To conclude….

We have to address the patients suffering from dysphagia with utmost empathy. Dysphagia is not only a physical condition , it also affects the person  mentally. treating a dysphagia patient is a long haul and we as doctors have to be patient with them and patients also need to understand this !! There are certain myths about dysphagia and it’s treatment and we need to create awareness about the same !! Me and you together need to create awareness !