Something went down the wrong pipe… or did it?

Disordered swallowing, or dysphagia, is important for people with Parkinson’s disease (PD), and other neurodegenerative diseases, to consider.  This is because most people with PD will develop dysphagia at some point during the course of the disease (the same is true for many other neurodegenerative diseases that we see at UF CMDNR).  However, when asked about whether or not they have difficulty swallowing, most of the time patients say “nope.”  It is only when a swallowing evaluation (a procedure done in radiology that takes a moving-picture x-ray of swallowing) is done that changes to swallowing safety are identified.

Why don’t patients always correctly identify that something has changed with their ability to swallow safely?

It seems like any change in the ability to swallow safely, or normally, should be obvious.  Things like coughing and choking are events we associate with something “going down the wrong” pipe (i.e., entering the airway).  However, many people with PD do not detect, or respond to material that has gone into the airway.  Therefore, they aren’t able to report the signs or symptoms that indicate they may be experiencing dysphagia.

Why don’t patients detect that material has entered the airway?

This is a question that we are working to answer.  Our research group has recently identified reduced urge-to-cough in patients with PD and trouble swallowing.  These results showed that patient’s with PD were not able to perceive a low-level cough stimulus in the same way that those without trouble swallowing could.  Our hypothesis is that because of the very gradual onset of swallowing changes over long periods of time, the sensory areas that should respond lose their sensitivity, resulting in small amounts of liquid going down the wrong pipe without the patient perceiving and responding to it.

What can patients do to prevent this from happening?

Pay attention to any irritation or “tickle” in your throat during or after swallowing.  That may indicate a small amount of liquid has gotten into the airway, and you should produce a strong cough to remove it.  Even if you aren’t coughing or choking during meals, ask your speech-language pathologist about a swallowing evaluation. There are treatments available, and early intervention is the key to preventing decline in function.

Want to contact us?

If you are interested in a speech and/or swallowing evaluation, please contact the Speech and Swallowing team at the Center for Movement Disorders and Neurorestoration.

If you are interested in more information about our research in the area of swallowing, cough and Parkinson’s disease, please contact the Laboratory for the Study of Upper Airway Dysfunction.

About the Author


Michelle Troche

Dr. Troche is currently an Assistant Professor in the Department of Speech, Language and Hearing Sciences in the College of Public Health and Health Professions…

Read all articles by Michelle Troche