Manual of Clinical Nutrition

Manual of Clinical Nutrition Management III- 35 Copyright © 2013 Compass Group, Inc.

DYSPHAGIA

Discussion
Causes of dysphagia are classified as mechanical (trauma or surgical resection of one or more of the organs of
swallowing) or paralytic (lesions of the cerebral cortex or lesions of cranial nerves of the brain stem).

Diseases and conditions in which dysphagia may result include the following:
 Head injury  Cancer of head or neck
 Brain tumors  Cerebral palsy
 Multiple sclerosis  Stroke
 Parkinson’s disease  Alzheimer’s disease
 Huntington’s chorea  Amyotrophic lateral sclerosis (ALS)
 Myasthenia gravis  Auds (oral candidiasis)
 Dementia  Laryngectomy (full or partial)

Signs and symptoms of dysphagia include:
 Drooling  Choking
 Retention of food in mouth  Squirreling of food in cheeks
 Coughing before, during, or after
swallowing

 Anorexia, weight loss, or malnutrition

 Gurgly voice qualities  Fatigue during meals

 Feeling of a lump in the throat  Spiking temperatures

 Pneumonia  Dehydration

 Aspiration of food or saliva

To define the therapeutic regimen, the multidisciplinary care team performs a comprehensive patient
evaluation, which may include assessment of the following:

 Diagnosis, treatments, surgical reports, and medications

 Protein-energy malnutrition and other nutrient deficits

 Energy and protein needs

 Indications for enteral feeding

 Olfactory and gustatory sensation

 Excessive salivation

 Food preferences and dislikes and typical meal pattern, elicited through patient and/or family

interviews

 Ability to self-feed

 Dentition

 Visual acuity

 Paralysis or paresis

 Obstruction

 Respiratory status

 Orientation, alertness, comprehension, memory, cooperation, motivation, emotional state, and

fear of choking

 Structure and function of all muscle groups involved in chewing and swallowing

 Pain associated with food ingestion or swallowing

 Onset, duration, and severity of swallowing problems

 Food consistencies that can be consumed safely, as determined by clinical evaluation at bedside

or by video swallow analysis

Approaches
See “Nutrition Management of Dysphagia” in Section IB.

Other Considerations
 In some patients with muscle weakness, avoid sticky foods, as they can adhere to the roof of the
mouth, thus causing fatigue. For example, bread may tend to “ball up in the mouth.” If this happens,
bread can be torn into small pieces and sprinkled into foods. Note: For some patients, sticky foods
(eg, peanut butter, caramels) may be used for exercise to improve tongue control, as recommended