2.2 Outline how to recognise the main types of dysphagia

This guide will help you answer 2.2 Outline how to recognise the main types of dysphagia.

Dysphagia is a medical condition characterised by difficulty or discomfort in swallowing. It can actually affect a person’s quality of life and, if not managed properly, can lead to serious health complications such as malnutrition, dehydration, and aspiration pneumonia. Recognising dysphagia is essential for providing appropriate care and interventions.

When Does Dysphagia Happen?

Dysphagia arises when there is a problem with any part of the swallowing process. Swallowing is a complex activity involving the mouth, throat, and oesophagus. Problems can occur at one or multiple stages, leading to different types of dysphagia.

There are generally two main types:

• Oropharyngeal dysphagia: This involves problems in the mouth or throat.
• Oesophageal dysphagia: This affects the oesophagus, the tube that carries food to the stomach.

Recognising these types early can prevent complications.

Oropharyngeal Dysphagia

What is Oropharyngeal Dysphagia?

Oropharyngeal dysphagia occurs when there is difficulty moving food from the mouth into the throat and oesophagus. It often involves neuromuscular disorders.

Signs and Symptoms

Here are common signs to look for:

• Coughing or choking: The person may cough or choke when trying to swallow.
• Nasal regurgitation: Food or liquid may come out of the nose during swallowing.
• Gurgly voice: There might be changes in the voice, often becoming wet or gurgly after eating.
• Difficulty initiating swallowing: The person may find it hard to start the action of swallowing.
• Recurrent chest infections: Frequent chest infections might indicate aspiration (food entering the airway).

These signs suggest that there may be a problem in the initial stages of swallowing.

Causes

Conditions affecting nerves and muscles often cause oropharyngeal dysphagia. Examples include:

• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Muscular dystrophy

Assessment

Assessors can use swallowing tests and observe eating behaviours to identify problems. A speech and language therapist often conducts a detailed assessment.

Oesophageal Dysphagia

What is Oesophageal Dysphagia?

Oesophageal dysphagia occurs when there is an obstruction or problem in the oesophagus, making it difficult for food to pass to the stomach.

Signs and Symptoms

Here are signs and symptoms to help identify oesophageal dysphagia:

• Feeling of food sticking: Patients often feel as though food is stuck in their chest or throat.
• Regurgitation: Partially digested food may come back up into the mouth.
• Heartburn: A burning sensation in the chest might be present.
• Weight loss: Unintentional weight loss due to difficulty eating enough.

These symptoms typically occur during or after swallowing.

Causes

Oesophageal dysphagia is often caused by:

• Obstructions: Tumours or strictures (narrowing of the oesophagus) can block food passage.
• Motility disorders: Conditions like achalasia affect oesophageal muscle contractions.

Assessment

An endoscopy or barium swallow test may be used to reveal the structure and movement of the oesophagus.

Recognising Red Flags

Being able to identify red flags is essential. These include:

• Rapid weight loss
• Recurrent pneumonia
• Severe dehydration or malnutrition
• Inability to swallow own saliva

Quick referral to medical professionals is necessary when these symptoms are present.

Practical Steps for Recognising Dysphagia

Observation

Care workers should:

• Watch for signs of difficulty at mealtimes.
• Note any changes in eating habits.
• Be alert to non-verbal cues like gestures indicating difficulty swallowing.

Communication

Engage with the person:

• Ask about their swallowing experience.
• Encourage them to express any discomfort or pain they feel.
• Ensure they feel supported.

Documentation

• Keep accurate records of observed symptoms.
• Document changes in behaviour or eating patterns.
• Record any weights and fluid intake if appropriate.

Common Complications

Without proper recognition and management, dysphagia can lead to:

• Aspiration pneumonia: Occurs when food or liquid enters the lungs.
• Reduced quality of life: Leads to social withdrawal and anxiety around eating.
• Poor nutritional intake: Results in fatigue and weakness.

Early recognition of symptoms can prevent these outcomes.

Support and Interventions

Role of Healthcare Professionals

Speech and language therapists, dietitians, and nurses work together to:

• Assess swallowing and nutritional needs.
• Develop individualised care plans.
• Provide exercises and methods to improve swallowing.

Strategies for Management

For care workers:

• Ensure the patient is in an upright position while eating.
• Recommend texture-modified diets if advised by healthcare professionals.
• Use adaptive utensils to support independence in eating.

These strategies can provide relief and improve the safety of eating and drinking.

Final Thoughts

Understanding and recognising the main types of dysphagia are essential components of providing care. Whether dealing with oropharyngeal or oesophageal dysphagia, recognising specific signs and symptoms will enable early interventions. Regular training and awareness can empower care workers to identify dysphagia effectively. This ensures patients receive prompt and appropriate support, reducing the risk of complications and improving their overall quality of life.