Simply Put

dysphagiaOne of many potential complications of Myositis, including those with Dermatomyositis, Polymyositis, and Inclusion Body Myositis, is dysphagia, or trouble swallowing. Myositis can cause the throat muscles to weaken, thus making meal times difficult and sometimes dangerous.

We should all be aware of what dysphagia is, learn about available treatments and procedures, and learn some tips that may provide help with swallowing food and liquids.

Dysphagia, can occur at any of the three stages in the swallowing process.

  • Oral phase: Sucking, chewing and moving food/liquid into the throat
  • Pharyngeal phase: Starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
  • Esophageal phase: Relaxing and tightening of the openings at the top and bottom of the esophagus and squeezing food through the esophagus into the stomach

Symptoms of dysphagia can include inability to start the swallowing process, pain, an excessive amount of saliva, persistent coughing or choking while swallowing, frequent heartburn, overnight coughing, feeling like something is stuck in the throat or chest, weight loss, and dehydration due to lack of eating and drinking and taking much longer than normal to finish a meal. These symptoms can cause poor nutrition, risk of aspiration pneumonia, less enjoyment of mealtimes, and even embarrassment in social situations, which could lead to isolation and depression.

With myositis, muscles of the throat and upper airway may be affected, resulting in dysphagia, nasal regurgitation of fluids, aspiration, and hoarseness.

Tips to help during mealtimes

  • Take small bites and small sips
  • Concentrate during meal times and while eating; try to avoid talking
  • Learn the consistency of foods that can be easily swallowed and avoid those that cause coughing and choking
  • Lean the head forward when swallowing. Avoid tilting the head back, as this will cause more complications while trying to swallow

While the tips above may help, there is no better alternative than seeing a Speech-Language Pathologist.

Soft and Bite-Size Food Information Sheets

Check out the information sheets provided by The International Dysphagia Diet Standardisation Initiative (IDDSI).

Level 6 Soft and Bite-Size Foods

Level 6 Soft and Bite-Size to Avoid

Seeing a Speech-Language Pathologist for dysphagia

Speech-Language Pathologists (also called speech therapists) are trained in swallowing disorders and are able to diagnose dysphagia using a few methods.

First, they observe the patient to check for correct posture and oral movements during eating and drinking while also looking at the strength of the muscles involved in swallowing.

Speech-Language Pathologists may also order tests such as a modified barium swallow where the patient will eat or drink food that contains barium and then the swallowing process is viewed on X-ray. An endoscopic assessment (a lighted scope is inserted into the nose and then the swallow can be viewed on a screen) may also be ordered to help make a diagnosis and to prescribe treatment.

Once diagnosed with dysphagia, a Speech-Language Pathologist will create a treatment plan that will include helpful information such as exercises to help improve muscle movement, positions, and strategies to help make swallowing more safe and effective. Speech pathologists may also teach about specific food/liquid textures and consistencies to provide the patient with a diet for easier swallowing.

Some therapies for dysphagia

  • Exercises that will help strengthen the throat muscles
  • Medications to help alleviate symptoms (in some cases)
  • Botox treatments
  • Throat stretching through use of endoscopy or surgery
  • Surgical cutting of certain muscles to allow for better swallowing
  • Deep pharyngeal neurological stimulation is an intense stimulation program of the oral-pharyngeal muscles. DPNS stimulates the cranial nerves by directly touching specific areas within the mouth and throat. This causes the pharyngeal and lingual muscles to contract. Over time, this strengthens the patient’s gag reflex and helps to improve long-term swallowing ability.
  • Thermal gustatory stimulation is a procedure performed by pressing a cold metal object against the back of the throat to elicit a swallow response. Improvements in swallowing ability are generally temporary.
  • Some patients may require a feeding tube which is placed directly into the stomach, therefore bypassing the mouth and swallowing process altogether.

While these tips, exercises, and treatments may be helpful, it is also a good idea to learn the Heimlich maneuver and CPR. You can find classes in your area.

Find CPR Classes

As a care partner, if you are not able to be home during mealtimes, some tips to make you feel comfortable may include:

  • Signing up for a lifeline-type system that can automatically summon EMT’s in the event of an emergency.
  • Leaving the front door unlocked if you are not going to be with your loved one during mealtimes, or have a lock box installed while coordinating with your local EMT’s and Fire Company so they have a way to get into your home.

Dysphagia-related studies and resources

  • Dysphagia in Patients with Sporadic Inclusion Body Myositis: Management Challenges

    Authors:  Nika Mohannak,1 Gemma Pattison,2 Kathryn Hird,1 Merrilee Needham 1,3,4

    Published: 5 December 2019 Volume 2019:12 Pages 465—474

    View Full Text

  • How to Cook for a Loved One with Dysphagia by Erin Embry MPA/MS CCC-SLP

    From Today’s Caregiver

    View Article

  • Meals for Easy Swallowing by The Muscular Dystrophy Associaton 

    Read/Download the PDF

Dysphagia Videos

Explanation of Dysphagia

Dysphagia & Thickened Liquids

Simply Put

“Simply Put” is a service of Myositis Support and Understanding, to provide overviews of Myositis-related medical and scientific information in understandable language.

MSU volunteers, who have no medical background, read and analyze often-complicated medical information and present it in more simplified terms so that readers have a starting point for further investigation and consultation with healthcare providers. The information provided is not meant to be medical advice of any type.

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