Coughing or choking while eating? When to see a Speech Pathologist
Have you noticed that you or a loved one is coughing after eating or drinking? Or perhaps they have even choked while eating recently. These can be signs of dysphagia and may require immediate assessment by a speech pathologist.
What is choking?
Choking occurs when something (usually food) completely blocks the airway causing a person to stop breathing. It is a critical medical emergency and requires immediate first aid.
Some of us have experienced an episode similar to complete choking, where we feel some food has “gone down the wrong way” but we are able to cough and expel the food.
What’s going on here and why does it happen? There are two tubes in our throats, one for breathing (trachea) and one for swallowing food and fluids (oesophagus). At the top of the trachea there is a cartilage called the epiglottis that folds down when we swallow, completely covering the entrance to the trachea and preventing food or fluids entering the airway.
Additionally, the vocal chords (or vocal folds) that sit below the epiglottis in the trachea, squeeze together when we swallow, adding an additional layer of protection to the air way.
If food or fluid slips down the back of the throat unexpectedly, the epiglottis and vocal folds may not react effectively and food and fluid can enter the airway.
What can go wrong?
Reduction in the strength and range of motion of our muscles that control chewing and manipulating food around our mouths can result in particles of food slipping down our throats before we are ready to swallow them.
Reduction in the strength and motility of the muscles that contribute to swallowing can result in pockets of food remaining in the sides of the lower throat. The food then has a greater chance of entering the airway once the body resumes normal respiration after a swallow.
Reduction in the sensory trigger that results in a reflexive swallow can result in a delayed swallow, allowing food to spill into the back of the throat before the body is prepared to swallow.
Reduction in motor control and sensory feedback can result in food remaining in the mouth that can be breathed in minutes or hours past the meal time.
What does coughing tell us?
A good strong volitional cough tells us that you have adequate ability to expel particles of food or fluid that has got through the first layer of defence, the epiglottis. When food or fluid hits our vocal folds, it triggers an automatic cough in an attempt to expel the particle.
If you notice you are coughing often during and after meals, if you are clearing your throat or your voice sounds wet and gurgly, it is a sign that food or fluids are penetrating your airway.
What is aspiration?
Aspiration occurs when small particles of food, fluids or even saliva enter the lungs. Coughing, throat clearing and a wet voice after meals is a sign that you may be aspirating.
Aspiration is a serious medical event that can result in aspiration pneumonia and death.
There are additional risk factors associated with aspiration pneumonia.
These are:
Poor oral hygiene. The bacteria in your mouth can enter your lungs and is more likely to result in pneumonia than aspirating on water alone.
Reliance on others for feeding.
Impaired health status. That is, difficulty fighting infections or lowered immunity.
Impaired mobility.
If you or a loved one has experienced choking or aspiration, it is important to reach out to a speech pathologist for an assessment. You can do this by contacting your GP for a referral.
What a speech pathologist can do to help
Changes to your diet may be warranted, such as thickening fluids or consuming softer foods. However, speech pathologists aim to support people to eat as normal a diet as possible while maintaining safety and will attempt to put in place other measures before modifying your diet.
Other measures
Rehabilitation. Depending on the cause of the dysphagia, the speech pathologist may prescribe rehabilitative exercises aimed at maintaining or improving swallow function.
Compensation. There are a number of compensatory strategies that can be put in place including postural changes, timing techniques and oral clearance techniques.
What the swallowing assessment looks like
During a swallowing assessment, the speech pathologist will test the muscles and nerves of your face and neck. They will observe you eating your typical diet and may request that you try other textures. This can take place in your home, in a clinic or over telehealth. While telehealth is not the preferred option, as the therapist cannot perform a hands-on assessment, research has shown that clinical decisions, safety judgments, and aspiration risk evaluations made remotely by speech pathologists show strong agreement with face-to-face assessments.
Once the assessment is completed the speech pathologist will make recommendations which may include:
A referral to a video fluoroscopy (a moving x-ray of your swallow)
Rehabilitative or compensatory exercises and strategies
Dietary changes
A mealtime management plan that outlines the recommendations
You will be asked to return for a follow up assessment any time from 3 to 12 months.
If modified foods or fluids are recommended
If the speech pathologist decides it is safer to modify foods, there is a framework (IDDSI) that can support you to put this in place in your own home. The speech pathologist can support you to do this, and you can access training courses both in person and online.
Training courses can support your understanding of the textures recommended and how to test whether foods and fluids comply with the recommendations. Training courses are also recommended if you are supporting a loved one with a modified diet. We offer online IDDSI training that can support you to build the skills you need to provide the recommended diet.
OSCAR Care Clinic also has dedicated and passionate speech pathologists with immediate capacity to undertake swallowing and communication assessments and intervention.
