Speech Therapy

Adults with difficulties swallowing are at risk of poor nutrition, dehydration, pneumonia or suffocation. Swallowing disorders may result from a number of medical conditions: 

• Neurological disorders: Such as stroke, Parkinson’s disease and dementia
• Cancers of the head, neck and oesophagus: People who have been treated for these cancers (e.g. oral cancer, laryngeal cancer, nasopharyngeal cancer, oesophageal cancer) may experience swallowing problems. The degree of the problem depends on the size and location of the tumour and the type and nature of the treatment used.
• Respiratory problems: Having a tracheostomy or needing a ventilator may affect one’s ability to swallow safely.
   

Common signs and symptoms of swallowing disorders:

• Coughing or choking when eating or drinking
• Wet or gurgly voice when eating or drinking
• Having the need to swallow many times to clear food from the mouth or throat
• Eating or drinking with effort
• Long meal times
• Food or liquid leaking from the mouth
• Recurrent pneumonia or fever
• Weight loss or dehydration
   

Treatment
After a swallowing evaluation, our speech therapist will recommend specific swallowing treatments. These may be in the form of exercises, recommendations on optimal feeding positioning, swallowing strategies or modifying liquid and food textures to allow for safer swallowing. The recommended treatment is based on the cause and presenting symptoms of the swallowing problem.

Feeding and swallowing problems can also occur in infants and young children. Causes may be congenital (e.g. malformations present at birth such as cleft lips and palate) or due to prematurity or neurological damage. Feeding and swallowing problems could also occur when the oral muscles are weak or there is abnormal sensation (oral hyper- or hyposensitivity). 

Children with feeding and swallowing problems are at risk of poor nutrition, dehydration and aspiration (food or liquid entering the airway). 

Common signs and symptoms of feeding and swallowing disorder:

• Poor sucking
• Refusing to feed
• Difficulty with chewing
• Excessive drooling or food/liquid coming out from mouth or nose
• Coughing during meals
• Difficulty coordinating breathing with feeding
   

Treatment
Treatments recommended by our speech therapists generally aim to increase the strength of the oral muscles, improve chewing, coordinate the suck-swallow-breath pattern or normalise oral sensitivity. Our speech therapist may also introduce safe textures and advise on postural changes or special feeding bottles and aids. Treatment is based on the cause and presenting symptoms of the swallowing problem.

Orofacial myofunctional disorders (OMDs) affect the growth, development and functions of orofacial musculature. OMDs can co-occur with speech or swallowing disorders. 

Common signs and symptoms of OMDs:

• Tongue protrusion between the teeth at rest, during speech or during swallow
• Mouth breathing
• Tongue tie
• Dental abnormalities
• Speech problem
• Drooling over age of 2 years
• Persistent sucking habits, e.g. thumb sucking, prolonged use of pacifier, tongue sucking, etc.
   

Treatment
Individuals with OMDs may benefit from orofacial myofunctional therapy. Depending on individual needs, other oromotor, speech or feeding therapy may be incorporated. Our speech therapists trained in orofacial myology will collaborate with other medical professionals to provide holistic management of OMDs.

VFSS is an objective assessment used to assess swallowing function. VFSS is conducted under X-ray and is typically done in conjunction with a radiologist. During VFSS, the individual with the swallowing problem is given food and liquid mixed or coated with barium, so that it can be seen under X-ray. During the procedure, the swallowing process is observed to identify the cause of the problem, determine the presence or absence of aspiration, and assess whether compensatory techniques could improve swallowing. Based on the VFSS findings, our speech therapist may discuss treatment and recommendations that aid safe swallowing.

FEES is an objective tool used to assess swallowing. The assessment uses endoscopy and is typically conducted with a specialist doctor. A flexible endoscope is inserted through the nose while food and liquids are swallowed. This allows the swallowing process to be visualised. Food and liquid given during the procedure may be of varying textures, and food colouring may be added to improve visibility. The goals of the procedure are to find the cause of the swallowing problem, assess the presence or absence of aspiration, and identify possible compensatory techniques.