Understanding It
What Dysphagia Is
Dysphagia is the medical term for difficulty swallowing. It can affect the oropharyngeal phase of swallowing (the mouth and throat), where food and fluids are prepared and transferred safely towards the oesophagus, or the oesophageal phase, where food and fluids travel from the throat to the stomach.
One reason swallowing is so complex is that the airway and the oesophagus share the same pathway through the throat. Safe swallowing relies on the precise coordination of muscles and nerves to protect the airway while allowing food, fluids, and saliva to pass into the oesophagus. When this process is disrupted, material can enter the airway instead of the oesophagus. This is known as aspiration and can increase the risk of chest infections, respiratory complications, and aspiration pneumonia.
Aspiration is not always obvious. Some people cough, choke, or experience a "wet" sounding voice when food or drink enters the airway. However, others may experience silent aspiration, where material enters the airway without triggering a cough or other visible signs. In these cases, recurrent chest infections, unexplained weight loss, dehydration, or repeated episodes of pneumonia may be the first indication that a swallowing difficulty is present.
Because swallowing difficulties can significantly affect health, nutrition, hydration, safety, and quality of life, early assessment is important whenever concerns arise.
How does it usually present?
- Difficulty swallowing tablets or capsules
- The sensation of food, fluids, or saliva sticking in the throat or chest
- Needing multiple swallows to clear a single mouthful
- Difficulty chewing, moving food around the mouth, or initiating a swallow
- Food or drink escaping from the lips, or drooling
- Food remaining in the mouth or collecting in the cheeks after swallowing
- Food, fluid, or saliva coming back up after swallowing
- Food or drink returning through the nose
- Taking significantly longer to finish meals
- Becoming tired, breathless, or fatigued while eating and drinking
- Avoiding certain foods, textures, or tablets due to swallowing difficulty
- Avoiding meals with others due to embarrassment or anxiety about swallowing
- Reduced appetite or eating less than usual
- Unexplained weight loss
- Signs of dehydration, including dry mouth, dizziness, or reduced fluid intake
- Frequent chest infections or recurrent pneumonia
- Significant distress, anxiety, or fear associated with eating and drinking
Seek medical advice if you experience coughing, choking, throat clearing, a wet/gurgly voice during or after meals, recurrent chest infections, pneumonia, unexplained weight loss, worsening swallowing difficulties, or food and fluids regularly "going down the wrong way". Seek immediate medical attention for choking that affects breathing or sudden swallowing difficulties accompanied by facial drooping, weakness, numbness, or changes in speech.
When to Act
When to Seek Help
You should consider a swallowing assessment if eating, drinking, or taking medications is becoming difficult, uncomfortable, or stressful.See your GP promptly for progressive difficulty over weeks, unexplained weight loss, food consistently sticking, painful swallowing, or a new hoarse voice lasting more than three weeks. Progressive swallowing difficulty in an adult needs medical investigation to identify the cause, not just management of the symptom.
Call 000 immediately if someone:
- Is choking and cannot breathe, speak or cough
- Has sudden difficulty swallowing along with face drooping, arm weakness or slurred speech — think F.A.S.T., this is a stroke until proven otherwise
Seek same-day medical assessment if there is:
- A choking episode requiring intervention
- Sudden onset of swallowing difficulty, or rapid worsening
- Complete inability to swallow, or the sensation of something stuck that will not clear
- Fever, breathlessness, chest pain or a productive cough in someone with known swallowing difficulty — possible aspiration pneumonia
- Signs of dehydration — very little urine, dry mouth, confusion, unusual drowsiness
- Coughing blood, or vomiting blood
Causes & Risk
What Causes It and Who Is at Risk
Swallowing difficulties can occur for many different reasons. In some cases, they develop because the muscles and nerves involved in swallowing are not working as efficiently as they once did. In others, swallowing may be affected by illness, injury, structural changes, or medical treatment.
Common causes of dysphagia include:
- Stroke
- Parkinson's disease
- Dementia
- Multiple sclerosis (MS)
- Motor neurone disease (MND)
- Acquired brain injury or traumatic brain injury
- Head and neck cancer and its treatment
- Gastro-oesophageal reflux disease (GORD/reflux)
- Oesophageal narrowing, strictures, or motility disorders
- Respiratory conditions affecting breathing and swallowing coordination
- Frailty and age-related changes to swallowing
- Certain medications that cause dry mouth, drowsiness, or reduced coordination
Swallowing difficulties can develop gradually or appear suddenly. They are not a normal part of ageing and should be assessed if there are concerns about safety, comfort, nutrition, or hydration.
How We Help
How Our Team Can Help
Speech Pathologists are the primary Allied Health professionals responsible for assessing and managing swallowing difficulties (dysphagia). Assessment typically begins with a clinical swallowing assessment, which may be completed in your home, residential care setting, or another familiar environment.
Management recommendations may include:
- Safe eating and drinking strategies
- Positioning and posture recommendations during meals
- Modifications to food textures and fluid consistencies using the International Dysphagia Diet Standardisation Initiative (IDDSI) framework
- Advice regarding medication administration where swallowing tablets is difficult
- Education for family members, carers, and support workers
- Referral for instrumental assessment or medical review when indicated
Speech Pathology
Clinical swallowing assessment, safe eating and drinking strategies, IDDSI texture and fluid modifications, mealtime environment and oral care recommendations, and referral for instrumental assessment (VFSS/FEES) where indicated.
Dietetics
Maintaining adequate nutrition and hydration, particularly when food textures or fluid consistencies have been modified — strategies to maximise nutritional intake and prevent weight loss.
Nursing
Day-to-day management of dysphagia: safe medication administration, monitoring hydration and nutritional intake, recognising signs of chest infection, and implementing swallowing recommendations in routine care.
Occupational Therapy
Seating and positioning during meals, adapted cups and cutlery, fatigue management, and upper limb function to improve independence, safety, and comfort during eating and drinking.
Where concerns cannot be fully explored through clinical assessment alone, a Speech Pathologist may recommend further investigations, such as a Videofluoroscopic Swallow Study (VFSS), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), or referral to a Gastroenterologist or other medical specialist.
Depending on the nature of the swallowing difficulty, referral to a GP, Gastroenterologist, Neurologist, Ear Nose and Throat (ENT) Specialist, or other medical practitioner may be recommended to investigate underlying causes and guide medical management.
Starting Out
What to Expect at Your First Appointment
Your Speech Pathologist will visit you in your home to gain an understanding of your swallowing concerns, medical history, and day-to-day experiences with eating and drinking. The appointment typically includes a discussion about your symptoms, the foods, drinks, or medications that may be causing difficulty, and any relevant health conditions or medications that may be contributing to swallowing problems.
The assessment will also include an examination of the mouth and the muscles involved in swallowing. Where appropriate and safe to do so, the Speech Pathologist will observe you eating and drinking. This is not a test that you can pass or fail. Instead, it helps us understand how swallowing works in real-life situations using the foods and drinks you would normally consume.
Following the assessment, you will receive:
- An explanation of the assessment findings
- Recommendations to support safe and comfortable eating and drinking
- Advice regarding food textures and fluid consistencies if required
- Practical mealtime strategies and positioning recommendations
- Education for family members, carers, or support workers involved in meal assistance
- A written report summarising findings and recommendations (sent to you, your GP or your care partner)
If further investigation or specialist input is recommended, we can assist with referrals and communication with your GP and other members of your healthcare team.
Ready to book?
Ready to get started?
Contact inOne Healthcare on 1300 765 456 or submit a referral online. Swallowing is assessed by our Speech Therapy team, working with Dietetics, Nursing and Occupational Therapy.
info@inonehealthcare.com.au
Flexible Options
Funding we accept.
Support at Home
For eligible older Australians, speech pathology, nursing, and dietetics are classified as clinical care services and are generally government-funded regardless of income or assets.
NDIS
For eligible participants under 65, speech pathology is commonly funded through Capacity Building: Improved Daily Living. This may include dysphagia assessment, intervention, mealtime management plans, and training for support workers and family members.
Medicare
A Chronic Condition Management Plan (formerly Chronic Disease Management Plan) from your GP may provide access to Medicare rebates for a limited number of allied health services each calendar year.
CHSP and Residential Aged Care
Eligible clients may be able to access speech pathology services through their existing aged care funding arrangements.
DVA
Eligible veterans may access speech pathology services with an appropriate referral.
Private
Private appointments are available, and a referral is not required. Self-managed and plan-managed NDIS participants can also access services privately where appropriate.
Free 20min Consultation
Unsure what support you need, or have funding enquiries? Book a free 20-minute telehealth consultation with our team.
Related: Stroke Recovery · Parkinson's Disease · Dementia Support · Communication After Stroke