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When Swallowing Difficulties Put a Damper on Dining

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Happy senior friends talking and eating at restaurant

Swallowing difficulties can make it difficult to enjoy a meal out. “It’s a huge quality of life issue for patients,” says University Hospitals otolaryngologist Nina Zhao, MD. “A lot of patients avoid restaurants because they can’t go out and have a meal without feeling like they’re choking, or they end up coughing through the meal.”

“The food is not enjoyable or they have to eat so slow, everyone else is done with the meal and they’re still working on the appetizer. I really feel for them.” Dr. Zhao shares tips for people with swallowing difficulties to enjoy meals with friends and family.

A Common Side Effect of Many Health Conditions

Difficulty swallowing is known as dysphagia. It’s fairly common and can have many causes, including neurological diseases, acid reflux, cancer and age-related decline of the swallowing function.

Symptoms of dysphagia include:

  • Coughing, choking and wet gurgled voice when eating or after eating.
  • The need for increased time and effort to eat a meal
  • Complaints of food or liquids sticking in the throat
  • Unintentional weight loss

The risks of dysphagia can be serious: malnutrition, dehydration, choking and aspirating. Dr. Zhao sees many patients who develop significant dysphagia due to strokes, Parkinson’s disease and cancer or surgical/radiation treatment. Patients with severe swallowing problems are at risk of aspirating food and liquid, which can lead to pneumonia.

The Isolation of Dysphagia

Eating and drinking is an important part of socializing for most people, and those with dysphagia often report feelings of isolation, stress and anxiety.

Signs and symptoms of dysphagia should be taken seriously and be medically evaluated, says University Hospitals speech pathologist Alexis Nahra. But many people with swallowing issues don’t recognize the symptoms or have modified their eating and drinking habits rather than seek treatment.

Many report trouble chewing, coughing through a meal or say they aren’t comfortable going to restaurants. “They say they can swallow, but they avoid salad and meat because it’s harder to eat, and they don’t realize they have a swallowing issue. We see this commonly in older adults,” says Nahra. “It can take them much longer to eat. They don’t want to be in a restaurant with everyone waiting on them while they try to eat.”

Tips for Dining Out

Dr. Zhao says what a person can and can’t eat depends on the individual and the problem underlying their dysphagia. “I would encourage people to think about ways to support their loved one so they can go out,” she says. “People may be embarrassed to talk about their swallowing issues. Maybe encouraging openness around this topic would be helpful for some people.”

She also emphasizes planning ahead. Choose restaurants with menus that have foods the person can eat, or or check whether a restaurant can make accommodations for patrons who have trouble swallowing.

“Most patients know what’s easy and what’s hard, or they have certain diet recommendations from a speech pathologist who specializes in swallowing,” she says.

“Some people are on liquids only or purees, or soft, minced, moist, easily chewable foods. I tell patients you know what you can and can’t eat and try to pick well. Talk to your servers and see what diet accommodations they’re able to do.”

Treating Dysphagia

“The best way to rehab a swallow is swallowing,” Dr. Zhao says. “It’s a use it or lose it phenomenon.” Therapy often involves teaching people how to swallow again, as many will develop maladaptive tendencies. Therapy teaches swallowing techniques to help patients tolerate different foods.

Treatment options also include surgery, depending on structural issues in the throat or esophagus. Medication to reduce acid reflux can help patients whose dysphagia is caused by gastroesophageal reflux disease (GERD). “It’s important for people to make sure they get seen and evaluated and plugged in,” Dr. Zhao says.

Related Links

University Hospitals has a multidisciplinary team dedicated to the diagnosis and treatment of dysphagia. Our team includes primary care providers, GI and ENT specialists, speech language pathologists and radiologists who work together to provide world-class, comprehensive dysphagia care, personalized to meet the unique needs of each patient.

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