Difficulty Swallowing (Dysphagia): Symptoms, Risks, and When to Seek an Assessment
Dr. Konstantinos Konstantopoulos · Professor of Speech and Language Therapy, University of Peloponnese · Nea Makri, East Attica
Coughing during meals, a “gurgly” voice after eating or drinking, or anxiety about something as simple as a glass of water? Difficulty swallowing is not a normal part of ageing.
An early assessment by a specialist speech and language therapist can help prevent complications such as aspiration pneumonia and show the safest way to eat and drink.
1. What is dysphagia, and why shouldn’t it be ignored?
Swallowing is one of the most complex functions of the human body. With every sip or bite, dozens of muscles in the mouth, throat (pharynx), and voice box (larynx) work together to move food into the oesophagus while protecting the airway (trachea).
When this process is disrupted, the condition is called dysphagia.
In my practice, I often meet families who believe it is “natural for an older person to choke on water”, or who wait weeks after a stroke patient comes home from hospital before seeking help. In fact, dysphagia is not a normal consequence of ageing and can lead to serious complications such as aspiration pneumonia, dehydration and malnutrition.
2. Warning signs: when should you be concerned?
Swallowing problems are not always obvious from heavy coughing. Sometimes food or liquid enters the airway with no visible reaction at all (known as “silent aspiration”). Watch the following signs:
Coughing or throat clearing during meals or straight after swallowing, especially with water and other thin liquids.
A “wet”, gurgly, or hoarse voice: if the voice changes after eating or drinking, as though there is liquid on the vocal cords, food or fluid may be left in the voice box.
Food left in the mouth: food collects in the cheeks, or the person struggles to chew it into a manageable mouthful and move it to the back of the mouth.
Difficulty or pain when swallowing: a sensation that “something is stuck” in the throat or chest.
Unexplained weight loss or reluctance to eat: the person becomes very tired during meals, eats very slowly, or avoids solid food and water for fear of choking.
Frequent unexplained low-grade fevers or repeated chest infections: these can be a sign that small amounts of food or liquid are reaching the lungs (micro-aspiration).
3. Who is at risk?
Stroke: more than half of people who have acute stroke exhibit some degree of dysphagia. Early intervention helps prevent pneumonia and establishes whether it is safe to eat and drink by mouth.
Dementia and Alzheimer’s disease: in the middle and later stages, when awareness during meals, coordination, and sensation in the mouth decline.
Surgery or radiotherapy to the head and neck.
General frailty or a long stay in intensive care: particularly after prolonged intubation or a tracheostomy.
4. What happens during a swallowing assessment?
The clinical assessment takes about an hour and includes:
A detailed medical history and examination of the mouth: I check movement, sensation and strength in the face, lips, tongue and palate, as well as the reflexes that protect the airway (coughing and throat clearing).
Carefully graded swallowing trials: small amounts of different textures (for example, water, thickened drinks, purée and solid food) are tried under controlled conditions while we monitor breathing, voice and movement of the voice box.
Clear recommendations for safe eating and drinking: where needed, I recommend further instrumental testing, such as an endoscopic swallowing evaluation (FEES) in collaboration with an ENT specialist.
5. What does therapy involve?
Adjusting food textures and thickening drinks (using special thickeners when water causes coughing).
Specific head and body positions that help protect the airway during swallowing.
Exercises to strengthen the swallowing muscles and retrain their coordination.
6. Questions families often ask
“If my husband/wife chokes on water, should I give him/her less to drink?”
Simply reducing fluids can lead to dehydration. Seek prompt advice from a specialist speech and language therapist and the treating doctor about how to maintain hydration safely. Thickened drinks may be recommended following a swallowing assessment, but they are not suitable for everyone. Do not change drink consistency without individual guidance.
“Can swallowing recover after a stroke?”
In most cases, yes. The brain can adapt (neuroplasticity), and the muscles can be retrained. The sooner targeted therapy starts, the better the chances of returning to safe eating and drinking by mouth.
“Our relative is fed through a tube (nasogastric/Levin tube or PEG). Will they be able to eat by mouth again?”
Often, yes, with gradual retraining. The assessment shows whether and when they can safely try small amounts by mouth, which textures to use, and in what position. Any decision to change or remove the tube is always made together with the treating doctor. Please do not give food or drink by mouth without this guidance.
Contact & appointments
If someone close to you has difficulty swallowing, coughing during meals, or sounds different after eating, please get in touch to arrange a thorough assessment. Assessments are carried out personally by Dr. Konstantinos Konstantopoulos, Professor of Speech and Language Therapy at the University of Peloponnese.