Speech therapy swallow assessment

Overview

A speech therapy swallow assessment is a check-up done by a speech and language therapist to see how well you can swallow food, drink, and saliva. It is often needed before or after surgery to make sure your swallowing muscles are working safely and to prevent choking or lung infections.

Swallowing difficulties are quite common, especially after certain surgeries (like head, neck, or chest operations) or in people with neurological conditions. Many people need a swallow assessment at some point after surgery.

It affects people of all ages, but is more common in older adults, people recovering from surgery (especially of the head, neck, or throat), those with stroke, dementia, Parkinson's, or after a long stay in intensive care.

Symptoms

Common symptoms

• Coughing or choking when eating or drinking
• Feeling like food is stuck in the throat or chest
• Bringing food back up (regurgitation)
• Taking a long time to eat a meal
• Losing weight without trying
• Having a wet or gurgly voice after eating or drinking
• Frequent chest infections or pneumonia

Symptoms in children

• Arching the back or turning the head away during feeding
• Crying or fussing during mealtimes
• Not gaining weight as expected
• Coughing or gagging while feeding
• Taking a very long time to finish a bottle or meal

Symptoms in older adults

• Avoiding eating or drinking because of fear of choking
• Eating very little or losing interest in food
• Unexplained weight loss
• Recurring chest infections or pneumonia
• Needing longer to finish meals than before

Causes

Main causes

• After surgery, especially on the head, neck, throat, or chest
• Stroke or other brain injury
• Nerve or muscle problems affecting the throat (e.g., Parkinson's, multiple sclerosis)
• Dementia or Alzheimer's disease
• Cancer or tumors in the throat, mouth, or esophagus
• Long-term use of a breathing tube or ventilator
• Aging – muscles can weaken over time

Risk factors

• Having surgery (especially general anaesthesia or surgeries that involve the throat)
• Getting older (over 65)
• Having a condition that affects the nervous system (like stroke, Parkinson's, dementia)
• Taking certain medications that dry the mouth or relax muscles
• Being in a hospital or nursing home
• Having a feeding tube or tracheostomy

When to see a doctor

See a doctor urgently if:

• You have sudden difficulty swallowing after a recent surgery or stroke
• You have high fever, chest pain, or trouble breathing along with swallowing problems
• You cannot keep any liquids down and feel dehydrated (dry mouth, dark urine, dizzy)

Book a routine appointment if:

• You have noticed a slow but steady change in your swallowing over weeks or months
• You often cough or choke when eating or drinking
• You avoid certain foods because they are hard to swallow
• You have unexplained weight loss or frequent chest infections

Diagnosis

A speech and language therapist will assess your swallowing by asking questions, watching you eat and drink, and sometimes using special tests to see inside your throat.

Tests that may be done

• Clinical swallow evaluation: The therapist watches you swallow different textures of food and drink while checking your mouth, throat, and voice.
• Videofluoroscopy: A moving X-ray video of you swallowing food and drink mixed with a special liquid (barium) to see exactly what happens.
• Fiberoptic endoscopic evaluation of swallowing (FEES): A small, flexible camera is put through your nose to watch your throat as you swallow.
• Bedside assessment: In hospital, the therapist may check your swallowing by your bed using simple tests.

What to expect at your appointment

You will be awake and sitting upright. For the X-ray or camera test, you may be given small amounts of food or drink. The tests are not painful, but you might feel a little uncomfortable. Results are often available right away, and the therapist will tell you if it is safe to eat and drink and what changes to make.

Treatment

Treatment for swallowing problems depends on the cause. A speech therapist works with you to find safer ways to swallow, and may teach you exercises or suggest changes to food and drink. Medical treatments may help the underlying condition.

Self-care at home

• Eat slowly and take small bites or sips
• Sit upright while eating and for at least 30 minutes after
• Avoid distractions like TV or talking while eating
• Alternate between bites of food and sips of liquid
• If recommended, thicken drinks with a commercial thickener (ask your therapist or pharmacist)
• Keep your mouth clean and well-hydrated

Medical treatments

Depending on the cause, doctors may treat underlying conditions like infections, nerve problems, or muscle weakness. Medications that make the mouth dry or affect muscles may be adjusted. A feeding tube (through the nose or into the stomach) may be used temporarily if it is unsafe to swallow. Surgery may be needed to widen a narrowed food pipe or to treat a growth.

When is surgery considered?

If swallowing problems are caused by a physical blockage (like a tumor or narrowed esophagus) or by a problem with the valve at the top of the stomach, surgery may help. The surgeon and speech therapist will work together to plan your care.

Living with this condition

Living with swallowing problems takes some adjustments. You may need to change what you eat and drink, and how you eat. Many people learn safe swallowing techniques and continue to enjoy meals with family and friends. It helps to plan meals ahead and allow extra time.

Lifestyle tips

• Keep a diary of foods and drinks that cause problems
• Tell your friends and family about your needs – they can help by serving softer foods or cutting food into small pieces
• Carry a water bottle and take small sips often if your mouth is dry
• If you use thickened liquids, always have thickener with you
• Stay active and keep your head up – good posture helps swallowing

Diet and exercise

Your speech therapist may recommend a special diet – soft, pureed, or with thickened liquids. Swallowing exercises, like tongue presses or throat lifts, can strengthen muscles. A dietitian can help you get the right nutrition and calories.

Mental health and emotional wellbeing

Swallowing problems can feel frustrating, embarrassing, or scary. You may feel anxious about eating with others or worry about choking. It is normal to feel this way. Talk to your doctor or therapist – they can help you find ways to cope and connect you with support if needed.

Prevention

Not all swallowing problems can be prevented, but some can be reduced. After surgery, early assessment and careful feeding can help. Staying healthy, keeping muscles strong, and managing chronic conditions may lower your risk.

Vaccines

Getting vaccinated against flu and pneumonia can help prevent chest infections if you have swallowing difficulties.

Screening programmes

If you are going into surgery (especially head, neck, or chest surgery), you may have a pre-operative swallow screening to identify risks early.

Complications

If left untreated

• Choking on food or drink – a life-threatening emergency
• Aspiration pneumonia – lung infection from food or liquid going into the airway
• Malnutrition and weight loss from not getting enough food
• Dehydration from not drinking enough
• Social isolation – avoiding meals with others due to fear or embarrassment

Long-term outlook

With proper assessment and treatment, most swallowing difficulties can be improved or managed safely. Many people get better over time, especially after surgery or stroke therapy. Even long-term problems can be lived with well using the right techniques and support.

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