Learning More about Speech and Swallow Dysfunction in MS

Learning More about Speech and Swallow Dysfunction in MS

Most of us are pretty well versed in the variety of symptoms that MS can cause, mostly thanks to our vast first-hand experience. I also have the advantage (or disadvantage depending on the day) of working in Neurology, so I know the anatomy and physiology behind all those peculiar MS symptoms. Throughout the years there have been several occasions where my expertise as a patient defy or even directly contradict my expertise as a clinician. For instance certain symptoms are thought to typically only happen in more advanced MS, or once a person has lived with it for a really long time. Issues with speech and swallowing are typically placed in this category, and are not generally thought by clinicians to be an issue early on. Imagine my surprise when only a year after my diagnosis I was eating my favorite food, bread (mmmm, bread), and it slipped right down the wrong pipe. That was the first “holy cow I’m really choking somebody give me the Heimlich QUICK” moment I’ve ever had. As scary as it was to choke, it happens to the best of us and I didn’t immediately leap to it being MS related…until it happened again, and again, and again. Either chunks of meat and bread were out to kill me, or this was definitely an MS symptom. I was hoping it was the latter, because a life spent avoiding meat and bread would be pretty bleak for this carnivorous Italian!

Luckily my best friend is a Speech Language Pathologist, so I called her up and picked her brain a bit. She was also surprised, wasn’t this something that only happened in advanced stages of MS?? Hmmmm. She gave me some professional pointers, and luckily over time it happened less and less. Pass the meatballs and garlic bread please!

Now as I treat more and more people with MS in my practice I make a point of asking about speech and swallowing during follow-up visits. At first I was somewhat surprised to learn that people of all ages and levels of disability reported having issues with at least one, if not both. Because we don’t have good data on MS prevalence it is tough to know exactly how many people with MS run into these issues. After doing a little bit of research on the topic I learned that around 40% of the MS population has difficulty with speech and/or swallowing at some point! That’s a significant number of people! To me it certainly means these symptoms are occurring across the MS spectrum, not just in the advanced stages. I thought it would be worthwhile to go over some of the basics and help spread awareness about these issues. I also want to go over what can be done to help both speech and swallowing.

Speech

MS can cause two different types of speech disorders. Dysarthria is slow, slurred, or quiet speech that is a result of poor or limited articulation. Dysphonia causes your voice change making it sound harsh, hoarse, overly nasal, or breathy. If you have a speech disorder it can be difficult for others to understand you, and sometimes people only realize they have an issue because other people point it out. If you think you are experiencing dysarthria or dysphonia you should bring it to your neurologist’s attention. Of course if you notice that your speech is slurred suddenly and you have other signs of a stroke you must to seek immediate medical attention.

Talking might seem like a pretty straightforward task, but it requires the coordination of around 100 different chest, neck, jaw, and facial muscles. If the nerves to any of these muscle groups or the movement of the vocal cords are affected by MS, you may suddenly find out first hand how difficult it can be to speak eloquently. If your neurologist agrees that it is a MS symptom they will likely recommend that you get an evaluation by a Speech Language Pathologist (SLP). The SLP will take a careful look at how all those muscles are moving and your breath control. Then, just like a physical therapist, they can suggest devices to help alleviate your symptoms and even give you exercises and that strengthen the muscles that control speech. Some people find that practicing their speech in a group or recording themselves talking helps them get the most out of their therapy. In some instances changes in your speech can be caused by muscle spasticity, and oral muscle relaxers and/or Botox can be used to alleviate symptoms.

Swallowing

The same muscles that you use to talk are used when you swallow. Difficulty with getting yourself to swallow, choking, coughing while eating or drinking, or frequently clearing your throat during meals can be indications of dysphagia, or a swallowing disorder. This is a potentially life-threatening issue because it can lead to choking and/or the aspiration of food or fluids into your lungs which can cause pneumonia. If you think you are experiencing dysphagia you should bring it to the attention of your neurologist immediately, and once again they will probably recommend an evaluation by a Speech Language Pathologist (SLP).

SLPs have a variety of diagnostic tests that they can do to figure out the exact cause of your swallowing issue. They start by watching you swallow different foods and liquids and observing how the muscles involved. They also have x-ray and video studies that can show them how each muscle group is moving while you chew and swallow. Based on these exams and tests they will recommend an individualized approach that will hopefully minimize your symptoms. For a lot of people changing the position of your head, paying close attention to the amount of food or liquid you take in at a time, alternating a bites of food with sips of liquid, and swallowing each bite twice can greatly reduce the risk of choking. The SLP may also have specific recommendations for what types or consistencies of food are best for you. It is also generally important to alway eat and drink while sitting straight up, and to keep your tongue and teeth as clean as possible to decrease the amount of bacteria in your mouth. If you find yourself getting really fatigued during mealtime it is very important to take a break, because that could increase your risk for choking. Small, more frequent meals might be the key if you are easily fatigued.

Have you ever had difficulty with your speech or with swallowing? Feel free to share your experiences with the community!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (23)
  • mardi63
    2 years ago

    Hi, I have issues with many things,like most of us, and swallowing is a major one. Things like bread, meats, root veggies etc..get caught and hang around for what seems to be forever. Most times it doesn’t cut my breathing, it happens farther down. Careful planning and beclofen seem to help.
    Lately I get severe hiccups. I mean like I feel like I am going to turn inside out. They come whenever they want, and leave when they want. Anyone else get these?
    Coughing started about 6 months ago and I go into fits several time a day, I have no cold or allergies that might cause this. ???
    Talking is difficult at times with slurring and stuttering.
    That’s my story and I would like to get rid of these symptoms.

    Thank you, Mardi

  • Nancy W
    2 years ago

    Interesting that this came up just now. I have been to th SLP, gastroenterologist, ENT !d pulmonologist because I have a chronic cough. The consensus is that I am having micro aspirations, which means I am breathing in small bits of foodmucus or saliva due to a swallowing defect.

    It is a tricky problem and I don’t have a solution. The GI Dr recommended I try a prescription dose of Prilosec for a month. I know my cough gets worse when I am active. This symptom has affect d my lifestyle more than any other since I stopped working 10 years ago.

  • poetgirrl
    2 years ago

    For many years before I was diagnosed, I seemed to choke easily, which I now know was probably caused by MS. I now try to eat smaller bites and chew more thoroughly, and that does help some. The strangest thing that has happened in the last few months is that sometimes when I swallow, the food will get caught just at the top of the sternum, and it is extremely painful. I’m not choking–I can still breathe–but the pain is intense. I’ve found that if I sit quietly and drink small sips of water, the trapped food will continue on down the esophagus, but it is so scary! I haven’t discussed this with my MS specialist yet.

  • KarenLoftus
    2 years ago

    Thank you, Stephanie! This was one of the first symptoms I had before diagnosis 4 years ago. Although each laryngeal spasm is scary, the worst ones for me are being woken up, unable to breathe (usually caused by acid reflux). I also now cough – I feel like something’s in the back of my throat. The GI Doctor I went to was more interested in my constant constipation and wanted to do a colonoscopy (my last one was 5 years ago) rather than investigate the upper GI as I asked – I didn’t go back. But this article has really made me rethink this and I’m going to find a different GI Doctor, just to make sure everything’s ok. AND I’m going to follow-up on getting a SLP.

  • poetgirrl
    2 years ago

    Hi, Karen, I’ve also had that experience of waking in the night unable to breathe–once this year and once a few years ago. I’m interested that it might be caused by acid reflux. I thought it was probably due to apnea, so I did an overnight sleep study, which indicated I have “mild” apnea, so mild that Medicare won’t pay for the breathing machine.

  • cw
    3 years ago

    Have been having this issue for a while. Had swallowing study end of last year. One doctor didn’t seem to really take it seriously as it wasn’t happening every day. Now thankfully, being sent for speech/swallowing therapy by my new ENT. I’ve already learned some quick tips. I’m happy that you shared the article. Thanks. We’re not alone.

  • Cheri RBT
    3 years ago

    I have yet to receive a clear diagnosis, but have been doing tons of research, so enjoy viewing these forums for help. These are two main symptoms that I have problems with and of course, they don’t happen all the time. When they do, I can’t talk clearly at all; often trying to say something that is spoken as a jumbled mess. Instead of “Can we go to the grocery store today?”, it will come out like, “Store, grocery, go, we can today?” I also have a lot of problems with articulation and clarity, often when trying to read out loud. Additionally, the swallowing has always been a problem for me, whether it’s liquid or solid. I choke SUPER easy on it all. I feel I have been living with MS half my life based on my own personal symptoms in comparison to my research, but have never had the insurance to get everything looked at. A big thanks to everyone who contributes to the site and forums. It is so amazing to know that I am indeed NOT crazy, and now I don’t feel so alone in dealing with this process. Kudos.

  • Laurie Wilczynski-Zollo
    3 years ago

    MS has caused me to have difficulty with speech, but I’ve found a helpful therapy. Learning another language (I’m currently learning Russian) has aided me immeasurably with both my speech and my memory. Since I live in a Russian neighborhood, I have occasion to practice, and everyone has been more than kind with my faltering attempts. I also find it fun!

  • jackie5275
    3 years ago

    I always knew my swallowing problems were due to MS because I never encountered them before this affliction. I don’t do anything special about it other than make sure I chew my food into a fine puree consistency like the bariatric surgery patients have to do. Then I have no problem.

  • Meagan Heidelberg moderator
    3 years ago

    Hi Jackie,
    Thank you for commenting and for being a part of our community! We appreciate your feedback.

    Meagan, MultipleSclerosis.net Team Member

  • Mpaulap2013
    3 years ago

    I was first diagnosed with spasmodic dysphonia in July, 2014. I had started getting hoarse in November, December 2013 before going to ENT. He checked me and said I could have 1 of 3 different things, one being the spasmodic dysphonia. It was confirmed in July, 2014. In the meantime, I had been seeing a neurologist for headaches and lesions on my brain. I had MRI done in October 2014, where one of my lesions previously had been 9mm, had shrunk to 7mm. I then had a spinal tap done and was diagnosed with MS in November, 2014. I had told my neurologist about my SD which caused him concern for my having the MS. I have tried the klonopin for a while until it quit working, but it DID help some with my voice. I am taking botox now to help with the SD. I really wasn’t 100% sure that MS could cause SD but now after reading this article, I am sure! Thank you!! BTW…I really don’t have any MAJOR symptoms with the MS…just the voice problem, so my neurologist says I have a mild case….not to say it can’t knock me off my feet tomorrow…..

  • Meagan Heidelberg moderator
    3 years ago

    Thank you so much for sharing your story, Mpaulap2013! So glad to know that our article helped you with some questions you had with MS. Thank you for coming by and being a part of our community! Hoping that your symptoms remain mild,

    Meagan, MultipleSclerosis.net Team Member

  • potter
    3 years ago

    The only problem is that I can’t speak very long my voice gets raspy and my throat gets a lot of flem. I have had to learn to keep conversations short. I always thought it was allergies kicking up Potter

  • Meagan Heidelberg moderator
    3 years ago

    Hi Potter, we do recommend our community to visit their physician/health team with any new or worsening symptoms. It’s definitely something to get confirmed by your physician! Thank you for being a part of our community,

    Meagan, MultipleSclerosis.net Team Member

  • 1mnccej
    3 years ago

    I initially had problems swallowing liquids but have now progressed to food as well. Things seem to get stuck in the ‘shelf’ (for lack of a better word) in my throat right above the start of my sternum (chest bone). I have learned over the years to stop for a second or two when I feel myself starting to choke, then when I resume swallowing things go down OK. My GI doc also has me on nortriptyline at bedtime and it works WONDERS! If I run out of it for a few days I find myself choking a lot more.

  • Meagan Heidelberg moderator
    3 years ago

    Thank you for sharing what works for you, 1mnccej! So glad that you found something that helps you! Thank you for being a part of our community.

    Meagan, MultipleSclerosis.net Team Member

  • Pamela
    3 years ago

    I’ve had problems with both. The swallowing was with a carbonated beverage. One time I couldn’t breath for a few seconds., My Nuro ordered a new MRI, no new T2 lesions, but the lesion load in the supratentorial was severe. My Daughter and Husband both say my speech is either slurred or halting at times. Not sure what to make of all of this.

  • Meagan Heidelberg moderator
    3 years ago

    Hi Pamela,
    We encourage our community members to speak to their physician/health team with any new/worsening symptoms. Thank you for sharing a part of your MS journey, as many of our community members will be able to relate!
    Thank you,
    Meagan, MultipleSclerosis.net Team Member

  • 3 years ago

    yes, i have mild swallowing issues. i saw a speech therapist – she watched me swallow different foods, felt my throat as i swallowed, we talked. i found it very hard to articulate what it felt like. she gave me some suggestions, some things to watch for, and told me to call if i felt any changes. difficulty swallowing, and the possibility of losing that ability, are some of the scarier ponies on the symptom merry-go-round.

  • itasara
    3 years ago

    I have had some problems, and I question myself is this MS or aging? something else perhaps? I am a singer and felt that I was not singing as well as I liked. Now I am getting older, and we all know that is a problem for some. It wasn’t something obvious to others as it was to me. So I went to an otolaryngologist who found I had some bowing of my vocal cords. Now this is usually age related but other causes the doc said as well, but he didn’t mention MS. So he sent me to a vocal physiologist and I learned some exerises which I do daily and I think it has helped, some days being better than others.
    My family complains they don’t always understand me.. and that could be part of the problem or is MS the culprit? I do not have progressive MS that I know of. This is my 10th year since diagnosis and I am over 67 now.
    I also find that certain foods cause me not to choke but to have some kind of (hard to explain) contraction feeling after I start to swallow. Certain foods like a handful of walnuts, for example. I don’t eat much bread but something bulky like that will trigger this response. This in my mind could be MS.
    I have mentioned here or elsewhere that after a bad cold three years ago I lost my smell and taste. A little has reoccured in the past two or three months. I was sure it was a virus from a cold which is why some of the damage is slightly returrning, but the disconnect from smelling something and actually tasting what I’m eating is another matter and I wonder if MS is involved. In fact I just read an article about this online yesterday, but it was a study that basically looked at a loss of tongue taste-salt, bitter, sweet, sour- in some MS patients except I never lost my tongue taste just the interpretation from my brain to know what I was tasting. So I heavily salted and sweetened my food to make it more enjoyable. This is slightly better now but not what I would call normal. Not much help from doctors. I jointed a group online and that has been helpful, but really there isn’t a whole lot to help this situation whether or not MS is the cause.
    As far as an SLP, I saw the speech therapist for about a month who said to call if need to. Not sure who else I’d see of the other problems, but unless there becomes a drastic change, I guess I don’t want to make any more appointments or spend any more money unless it seems there is a promising reason to to do so.
    Thanks for your article. I think it is a topic that needs to be talked about.

  • Cheri RBT
    3 years ago

    I was curious as to whether you used any Zicam products during your cold…? These were recalled for a certain time frame and are said to have caused smelling and tasting deficiencies. From what I understand, there was/is a class action lawsuit involved.

    https://www.lawyersandsettlements.com/lawsuit/zicam.html#.VvKRVLNOmKA

  • Diana M.
    3 years ago

    Hi, itasara, after reading this article right here on this same website: https://multiplesclerosis.net/living-with-ms/taste/comment-page-1/#comment-15416

    …I’ve been wondering whether anyone else had experienced the same weird disconnect between smell and taste that I had for a time. Your description of the effect since your cold sounds similar to what happened to me during the major flare that led to my diagnosis.

    I sure do hope your taste sensation continues to improve.

  • Mary-Louise
    3 years ago

    As with Itasara and Potter, my voice became hoarse and sometimes raspy less than a year ago. Phlegm also lurks back in my throat, too.

    I’ve been gifted with a fine singing voice (with a number of songs professionally recorded), but now rarely sing because it’s too much of a hassle. I don’t miss the singing that much since, as a song-writer, I’ve become more interested in that.

    My neurologist referred me to an e.n.t. doctor who, through a video-strobe crossed out the possibility of any growths.He referred me to a speech therapist which had negligible results. (I already knew about breathing from the diaphragm.)

    I’m suspecting that I might be dealing with some allergies and have an appt. in a few weeks with an allergist. I’m 67.

    Blessings to you all and thanks!

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