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Dysphagia Treatment: Swallowing Therapy

Swallowing is the complex coordination of muscle contractions between the mouth, tongue, throat and esophagus. Dysphagia, or difficulty swallowing, results when one or more of these areas does not function properly due to trauma, surgical nerve or muscle damage, chemotherapy or radiation treatment. The ability to swallow properly ensures healthy nutrition and protects against aspiration of food particles or choking.

Dysphagia Treatment: Why Choose Johns Hopkins?

SLP running a swallowing test with patient
  • The Johns Hopkins Department of Otolaryngology – Head and Neck Surgery comprises a specialized team of surgeons and speech-language pathologists (SLPs) working side by side to provide you with the full spectrum of treatment.
  • SLPs support your care and recovery with innovative approaches and new technologies. Your therapy plan may include swallowing exercises and recommendations for diet and behavior modifications. 
  • Our team has expertise in the latest treatment methods for even the most complex dysphagia cases. 

Dysphagia Treatment: What to Expect

Swallowing Tests

The first step is a swallowing test. There are three types of swallowing tests done by SLPs. The test recommended for you depends on your diagnosis and ability. Your doctor may also recommend a swallowing test to determine the cause of a chronic cough or as part of a comprehensive head and neck cancer evaluation. 

All tests will start with a review of your medical history and symptoms, as well as testing of the muscles of your face and mouth to evaluate muscle strength and function. The SLP will then ask you to swallow a variety of substances that can include thin liquids, thicker liquids, pureed foods and regular food. 

Basic swallowing test: You will eat and drink normally while the SLP observes. 

Fiberoptic endoscopic evaluation of swallowing (FEES): A small scope is placed through your nose so the SLP can watch the inside of your throat while you eat and drink. 

Modified barium swallowing test (cinepharyngoesophagram): You will be asked to swallow a variety of substances mixed with barium so the SLP can see your swallowing during an X-ray study. Under close observation, the SLP will look for signs of swallowing dysfunction or aspiration. The results of the test inform your treatment.

Your SLP will coordinate treatment with your care team, which may include otolaryngologists, gastroenterologists or neurologists. Depending on the results of your swallowing test, your SLP may recommend additional assessments or treatment approaches provided by these specialists.   

Dysphagia Treatment After Cancer

Cancer treatments are a common cause of dysphagia. Chemotherapy and radiation treatments can damage the sensitive tissues of the throat. Surgery for cancer can also affect nerves and muscles essential to swallowing.

Our team treats a large number of patients who are undergoing cancer treatment, providing us with a rare degree of skill and expertise in addressing even the most complex swallowing problems.

Learn more about head and neck cancer treatment at Johns Hopkins.

Swallowing with a Prosthesis

You may need a prosthetic device, such as a palatal prosthesis or obturator, to swallow safely if you have undergone a partial palatectomy or maxillectomy or if you are living with ALS. If you require a prosthetic device, you will be referred to a dental surgeon to create one. Your therapist will work with you so you can learn to use your new device comfortably and safely. 

Dysphagia Treatment After Surgery

Surgery to address thyroid, spine, brain, lung or heart disease can cause damage to nerves and muscles important for swallowing. The SLP will work with you to identify these injuries and can help determine whether or not complementary treatments provided by our surgeon colleagues — such as vocal cord injections — may be helpful.

If you have undergone nerve grafting surgery to address facial paralysis, our SLPs provide rehabilitation, including testing your lip strength to make sure you are able to create a strong lip seal for safe and healthy swallowing and good speech production.

Learn more about facial paralysis surgery

Our Speech-Language Pathologists

Photo of Dr. Rina R.T. Abrams, M.S.

Abrams, Rina R.T., M.S.

Assistant of Otolaryngology - Head and Neck Surgery
Speech Language Pathologist
Photo of Dr. Ashley Corrinne Davis, M.S.

Davis, Ashley Corrinne, M.S.

Assistant of Otolaryngology - Head and Neck Surgery
Photo of Dr. Kristine M. Pietsch, M.A.

Pietsch, Kristine M., M.A.

Assistant of Otolaryngology - Head and Neck Surgery
Speech Language Pathologist
Photo of Dr. Donna Clark Tippett, M.A., M.P.H.

Tippett, Donna Clark, M.A., M.P.H.

Associate Professor of Otolaryngology - Head and Neck Surgery
Associate Professor of Neurology
Associate Professor of Physical Medicine and Rehabilitation
Speech Language Pathologist
Photo of Dr. Kimberly Webster, M.A., M.S.

Webster, Kimberly, M.A., M.S.

Assistant Professor of Otolaryngology - Head and Neck Surgery
Assistant Professor of Neurology
Speech Language Pathologist