Swallowing is a complex process. Some 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. This happens in three stages. Speech Pathologists work with the first two phases, and sometimes assist Gastroenterologists with diagnosis in the third phase, the oesophageal phase.


During the first stage, called the oral phase, the tongue collects the food or liquid, making it ready for swallowing. The tongue and jaw move solid food around in the mouth so it can be chewed. Chewing makes solid food the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. Normally, the only solid we swallow without chewing is in the form of a pill or capsule. Everything else that we swallow is in the form of a liquid, a puree, or a chewed solid.


The second stage begins when the tongue pushes the food or liquid to the back of the mouth. This triggers a swallowing response that passes the food through the pharynx, or throat (see figure). During this phase, called the pharyngeal phase, the larynx (voice box) closes tightly and breathing stops to prevent food or liquid from entering the airway and lungs.

Humans swallow roughly 900 times per day. People who have trouble swallowing are at risk of poor nutrition and hydration. Swallowing difficulties (dysphagia) are common in the following populations:

  • Cancer of the head and neck

  • Stroke (over half of people who have a stroke will develop swallowing difficulties)

  • The ageing process including loss of dentition, frailty, deconditioning or ill-fitting dentures

  • Dementia and other cognitive disorders

  • Degenerative diseases including Parkinson’s Disease or Motor Neuron Disease

  • Some autoimmune disorders including Scleroderma

  • Respiratory diseases including COPD


If someone you know presents with any of the following signs, it might mean they have dysphagia and early intervention is important:

  • Difficulty chewing certain foods

  • Holding food/drink or saliva in the mouth

  • Taking a really long time to get through a meal

  • Coughing when eating or drinking, or complaining of a “tickle” in the throat (aspiration)

  • Choking when eating or drinking

  • Complaining of food or drink sticking in the throat


The impact of dysphagia can be very detrimental to someone’s health. Some of the complications can include:

  • Aspiration pneumonia (chest infection caused by food/drink or saliva entering the lungs) recurrence can eventually lead to death

Aspiration pneumonia with recurrence can lead to significant morbidity and mortality.

  • Dehydration and malnutrition


It is really important for early identification of dysphagia to avoid any adverse outcomes. At Hastings Macleay Speech Pathology we will provide a thorough assessment of swallowing and make it a priority to ensure eating and drinking is an enjoyable experience. Your safety is our priority and we will aim to eliminate risks of choking or developing a pneumonia and subsequently a visit to hospital.