Dysphagia (Swallowing Disorders)

Experts at the Grabscheid Voice and Swallowing Center of Mount Sinai specialize and excel in the diagnosis, evaluation, and treatment of swallowing disorders, ranging from routine to very complex. Mount Sinai has had a longstanding and reputable history of treating stroke and non-stroke related swallowing disorders since 1922. We employ a unique multidisciplinary approach, cutting edge technology, access to multiple means of screenings, and unparalleled expertise in the management and treatment of these disorders, which enable us to treat each patient with a high amount of success and satisfaction.

About Dysphagia (Swallowing Disorders)

Swallowing involves the passage of saliva, liquids, and all consistencies of foods through the mouth, throat, and esophagus. Dysphagia is a difficulty or impairment in that function.  Difficulty swallowing can occur in children and adults. It is especially common in the elderly and with individuals with neurologic conditions.
Patients with suspected swallowing problems should be carefully evaluated by a trained professional and appropriate treatment initiated in order to prevent complications from their swallowing disorders, such as dehydration, malnutrition, choking and pneumonia.

Common symptoms of a swallowing disorder include but are not limited to:

  • Coughing during or after eating or drinking
  • Unexplained weight loss
  • Food or liquid “going down the wrong way”
  • Gagging or choking
  • Throat clearing
  • Chronic cough
  • Painful swallowing
  • A feeling of a lump in the throat
  • Increased time to eat
  • Wet, gurgly voice or breath sounds

What Causes Dysphagia?

Dysphagia may be caused by many different factors. Among the more common reasons for swallowing problems are a stroke, head injury or spinal cord injury, a progressive neurologic disease such as Parkinson's disease, multiple sclerosis, myasthenia gravis or ALS, head, neck or esophageal tumors and their treatment (surgery or radiation), medical problems such as rheumatoid arthritis, scleroderma and diabetes, acid reflux, a paralyzed vocal cord, the presence of a tracheotomy tube, poor dentition or ill-fitting dentures. In addition, the muscles involved in swallowing weaken as a function of aging and have an effect on swallowing after the age of 65 this is referred to as sarcopenia.

Many swallowing disorders may be helped by swallowing therapy. A speech-language pathologist can provide patients with diet modifications, special exercises to help strengthen the swallowing muscles.

Swallow Evaluations

At Mount Sinai we provide multiple options for swallow screenings and evaluations to satisfy patients’ preferences and goals. Every patient is given an in-office clinical assessment of swallow prior to any objective measure to assess if an objective measure is warranted and which evaluation is appropriate. We follow the gold standard of care, and clinical assessments are conducted routinely for all populations. Swallow evaluations include:

In Office:

  • Static endoscopic evaluation of swallow (SEES): this transoral endoscopic evaluation documents the presence or absence of post-swallow residue and aspiration, and is an effective indicator for determining further workup.
  • Fiberoptic Endoscopic Examination of Swallow (FEES): this routine swallowing study assesses swallow function by viewing the pharynx, larynx and esophagus using a small, flexible camera. This test can be performed with and without sensory testing and

Out of Office:

  • Modified Barium Swallow (MBS) in In Radiology Suite: this real-time, fluoroscopic X-ray exam involves ingesting foods and liquids containing barium sulfate (contrast dye) to study the swallow function and determine if food or liquid is entering the lungs (aspiration).

Swallow Treatments

Many swallowing disorders may be helped by swallowing therapy. A speech-language pathologist can provide patients with diet modifications, special exercises to help coordinate and strengthen the swallowing muscles. Based on the outcome of the evaluation, a treatment plan is provided. Treatments include:

  • Diet modification
  • Compensatory posturing
  • Thermal stimulation
  • Therapy techniques
  • Muscle strengthening exercises
  • Adaptive equipment
  • Consideration of medical-surgical alternatives
  • Aspiration precautions
  • Patient and caregiver education