Dysphagia: warning signs and when to see a speech therapist

Does your family member take a long time to eat? Do they cough during or after meals? Have they lost weight for no apparent reason or had repeated pneumonia? These can be symptoms of dysphagia, a swallowing disorder that affects millions of people — especially older adults and neurological patients — and which, if untreated, can have serious health consequences.

Dysphagia is far more common than is generally thought, and it often goes unnoticed until complications arise. Knowing how to recognise its warning signs can make all the difference.

What exactly is dysphagia?

Dysphagia is difficulty swallowing solid, semi-solid, or liquid foods. It is not a disease in itself, but a symptom that can result from multiple conditions: stroke, amyotrophic lateral sclerosis (ALS), Parkinson's disease, dementia, head and neck cancer, trauma, advanced ageing, or other neurological or oncological conditions.

The act of swallowing, which we perform between 400 and 600 times a day, involves the precise coordination of more than 30 muscles and several cranial nerves. When something goes wrong in this complex mechanism, food or liquid may be diverted into the airways instead of heading towards the oesophagus — a process known as aspiration.

Warning signs: symptoms you should not ignore

Any of the following symptoms may indicate the presence of dysphagia and requires a speech therapy assessment:

Frequent coughing during or after eating or drinking. This is one of the clearest signs that something is wrong with the swallowing process.

The feeling that food is "getting stuck" in the throat or chest. Although this can have other causes, this symptom should never be ignored.

Wet or "gurgly" voice after eating. This indicates that there are food or liquid residues on the vocal cords or in the pharynx.

Drooling or losing food from the mouth. This reflects poor oral control during the preparatory phase of swallowing.

Avoidance of certain foods or changes to diet. The patient unconsciously avoids textures or consistencies they find difficult to swallow.

Excessively long mealtimes (more than 30-45 minutes). Eating should be a comfortable act, not an exhausting task.

Unexplained weight loss or malnutrition. If eating hurts, is frightening, or is difficult, the person unconsciously reduces their intake.

Repeated respiratory infections or pneumonia. This is the most worrying sign: it may indicate silent aspiration — food passing into the lungs without visible coughing.

The silent danger: silent aspiration

One of the most concerning aspects of dysphagia is that in many cases aspiration occurs without the patient coughing or showing obvious signs. This phenomenon, known as silent aspiration, is particularly common in people with neurological damage and can cause recurrent aspiration pneumonias that put the patient's life at risk.

The only way to detect silent aspiration is through a specialised clinical assessment and, in many cases, instrumental tests such as videofluoroscopic swallowing study (VFSS) or fibreoptic endoscopic evaluation of swallowing (FEES), which allow direct visualisation of what happens when the patient swallows.

Who is most affected by dysphagia?

Although dysphagia can occur at any age, the highest-risk groups are:

Older adults. With ageing, swallowing muscles lose strength and coordination. It is estimated that dysphagia affects 15-40% of people over 65.

Neurological patients. Stroke, Parkinson's, Alzheimer's, ALS, and multiple sclerosis are frequent causes of dysphagia.

People with head and neck cancer. Surgery, radiotherapy, and chemotherapy can significantly alter the anatomy and function of the structures involved in swallowing.

Intubated patients or those with tracheostomy. Prolonged mechanical ventilation can impair swallowing function.

How does a speech therapist assess and treat dysphagia?

The speech therapist specialising in dysphagia carries out a thorough assessment that includes bedside clinical evaluation, analysis of oromotor structure and function, and the application of validated tests such as the Volume-Viscosity Swallowing Test (V-VST). When necessary, they coordinate referral for instrumental tests.

Treatment is designed individually and may include: orofacial rehabilitation and swallowing muscle exercises, compensatory manoeuvres, food texture and viscosity adaptation according to the IDDSI framework, postural strategies, and education for the patient and family.

Do not wait to seek help

Dysphagia does not always improve on its own over time. Without treatment, complications can be serious: pneumonia, malnutrition, dehydration, and in the most severe cases, the need for tube feeding. Early speech therapy assessment and treatment is the best investment in health and quality of life.

If you recognise any of these warning signs in yourself or a family member, request an assessment with a speech therapist specialising in dysphagia. At my practice in Málaga, I see patients of all ages with swallowing disorders and we work to ensure safe, efficient, and, as far as possible, enjoyable nutrition.