How can I tell if my loved one has a swallowing problem?

Expert wife and husband team, Roya Sayadi, PhD, CCC-SLP and Joel Herskowitz, MD, answer this question.

Swallowing can be tricky. It’s not something we usually pay much attention to until there’s an obvious problem like choking or gagging.

How can you tell if your loved one has a swallowing problem?

These are some of the things people complain of when they have difficulty swallowing:

“The food doesn’t go down.”
“I have to swallow more than once.”
“Tears come to my eyes when I eat.”
“My nose runs at mealtimes.”
“Pills get stuck in my throat.”
“I cough when I drink water.”
“The food falls out of my mouth.”
“I have a hard time eating steak.”
“When I swallow, juice goes up my nose.”
“It hurts when I swallow.”
“I’m afraid I’m going to choke.”
“My voice sounds funny after I eat.”
“I get so tired, I can’t finish a meal.”

Sometimes a person has no complaint at all – but a very real problem with swallowing.

What’s so bad about having a swallowing problem?

Potentially, a lot! Swallowing problems can be fatal. They can lead to death by choking, pneumonia, or malnutrition. Swallowing problems account for tens of thousands of lives lost annually in the United States.

What causes swallowing problems?

Keep in mind that swallowing is more than a one-step gulp-it-down. It’s a process. First, you chew the food. Then your tongue carries it back to the throat. There the swallowing reflex takes over and moves the food on to the esophagus.

Different diseases can affect swallowing at any step in the process. Some causes are structural. Something is missing (due to birth defect, injury, or surgery) or extra (such as a tumor, cyst, or diverticulum). Some causes are neurologic – for example, Alzheimer disease, Parkinson disease, stroke, multiple sclerosis, or ALS). Some causes are general – congestive heart failure or COPD, for example.

You may need to become Sherlock Holmes to suspect a swallowing problem. There may be no obvious symptoms related to swallowing. Unexplained fever, particularly if associated with pneumonia, is a classic. This can result from food or liquid slipping into the respiratory tract to cause pneumonia (called aspiration). Sometimes the only clue will be unexplained weight loss.

What should you do if you suspect a swallowing problem?

Print this article and circle the symptoms your loved one is showing. Jot down additional concerns you might have. Get this information to the primary medical provider. She or he can then assess the situation and decide whether it calls for evaluation by a swallowing specialist. Make sure you know how to do the Heimlich maneuver and when to call it into play.

Keep in mind that you’re not overreacting or being hysterical. You’re doing the right thing by seeing that a small problem doesn’t become life-threatening.

Roya Sayadi, PhD, CCC-SLP, is a speech-language pathologist with the Natick (Massachusetts) Visiting Nurses Association.
Joel Herskowitz, MD, is a member of the Boston University School of Medicine faculty.
Sayadi and Herskowitz are authors of SWALLOW SAFELY: How Swallowing Problems Threaten the Elderly and Others. A Caregiver’s Guide to Recognition, Treatment, and Prevention.[TCV Update 2/1/2022 Sayadi and Herskowitz’s website URL is broken. URL is now to their book on Amazon.com]