Overview
Dysphagia is defined as an impairment of the swallowing process and can lead to serious complications, such as dehydration, malnutrition, and potentially fatal aspiration pneumonia1. In oropharyngeal dysphagia (OD) the impairment affects the oral preparatory, oral and/or pharyngeal swallowing phases. Dysphagia affects 13% of community-dwelling older adults, increases to 33% in olders over 85 years old, and reaches 46.98% in nursing home residents2. In cases of acute or progressive neurological disorders, dysphagia affects 42% of people post-stroke3, 58% of those with dementia4, and 50% of patients with head and neck cancer who have undergone surgery and adjuvant therapy5. Without proper management, it can lead to severe consequences, including malnutrition, aspiration pneumonia, and dehydration
Symptoms
Identifying symptoms of Oropharyngeal Dysphagia (OD) is crucial for timely intervention and to avoid severe consequences. Patients may experience difficulty initiating and/or repeating swallowing, often localizing the issue to the cervical area6. Accompanying symptoms can include the need for multiple swallows per bolus, the presence of oral or pharyngeal residue, coughing during or after swallowing, and a ‘wet’ or gurgling voice after swallowing6-7. Additionally, throat clearing after swallowing to clear accumulated residue is common. Other signs such as nasal regurgitation, choking during or after swallowing, recurrent fever of unknown origin, recurrent pneumonia, and weight loss should also be monitored.
Diagnosis
Early detection through the observation of specific signs and symptoms, typically during meals, or through validated screening questionnaires and comprehensive evaluation, is essential for effective treatment and improved patient outcomes. The Eating Assessment Tool-10 (EAT-10) is a validated questionnaire developed as a quick, easy-to-understand, and self-administered screening tool to evaluate dysphagia symptoms across various clinical settings. It is widely available in different languages8.
Click here to find the tool in different languages.
Patients who fail the initial screening may be referred to specialized healthcare professionals for thorough evaluation through clinical or instrumental assessments, such as fiberoptic endoscopy or videofluoroscopy evaluation of swallowing tests, to obtain a definitive diagnosis.
Intervention
Bolus modification is a mainstay of the intervention in the nutritional management of patients with OD. Bolus modification is a well-established, evidence-based technique for reducing symptoms and clinical complications of OD. The implementation of this strategy for patients with OD is supported by clinical practice guidelines9,10 and consensus paper11. Bolus modification involves adjusting the viscosity, volume, and temperature of the bolus of liquids or solid food.
Thickening agents formulated for medical purposes are essential for modifying bolus consistency. Xanthan gum-based thickeners, such as ThickenUp® Clear, have been clinically proven to enhance swallowing safety and efficiency12. These thickeners are favored for their stability and consistency, reducing the risk of aspiration and choking by providing a controlled, slow-moving bolus through the oropharynx, thereby improving swallowing coordination. Additionally, they do not significantly alter the taste of food and beverages, increasing patient acceptability.
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