It is estimated that 30% to 35% of people with MS develop a problem with swallowing (dysphagia). The specific nature of swallowing problems that occur in MS depends on the location of lesions or scars formed in the CNS from demyelination. Swallowing involves about 30 muscles in the mouth and throat and is controlled by 8 different cranial nerves.
Problems that can result from dysphagias
Slowing of nerve impulses controlling swallowing
- Can interfere with chewing and initiation of pharyngeal swallow
- Can affect the strength and range of movement of muscles used to move food through mouth, throat, and esophagus
Decreased muscle strength and coordination
Can result in particles of food remaining in mouth, throat, or esophagus after swallowing, increasing risk for aspiration
Delay in triggering pharyngeal swallow
Food can fall into airway and pass into the lung before swallow is triggered
Malfunction in valves in throat
Escape of food or drink down windpipe or into nose during swallow
How are swallowing problems evaluated?
Swallowing problems are evaluated by a speech/language pathologist. This specialist will take your clinical history, asking you questions about how long it takes you to eat a meal, history of heartburn or indigestion, whether you have experienced coughing or choking while eating, and whether you have a history of respiratory infections. This is followed by a thorough examination of the muscles in your mouth and throat and your ability to control them. Typically, you are asked to move your lips, tongue, and soft palate and produce vocal sounds that show how well you can control the muscles in your mouth and throat.
In addition, an evaluation of swallowing usually includes a type of radiographic imaging study called a videofluoroscopy. You are given a solution of barium to swallow, which makes the different parts of your mouth and throat visible on the x-ray video. The videofluoroscopy will record the movements of the structures of your mouth, throat, and esophagus as you chew and swallow different types of food and liquids.
How are swallowing problems treated?
Swallowing problems are usually treated using exercises to increase the strength of muscles used in swallowing. Although the needs of every individual will be different, swallowing therapy is typically given twice a week for a couple months. Following that, you can use your training to continue exercises on your own.