Dysphagia is difficulty or disruption of any stage of the swallow process.

This
may be due to structural, developmental, or neurological impairment. Structural
difficulties include conditions such as cleft palate or cancers affecting any of
the structures involved, such as the tongue or the larynx. Conditions causing
developmental, physical, and learning difficulties may also result in dysphagia.
Dysphagia is a common consequence of stroke and other acquired neurological
conditions.
The main risks associated with this dysphagia are malnutrition, dehydration,
when the person is not getting enough food or drink, or aspiration, when
material enters below the level of the vocal cords and the normal response to
aspiration is to cough.
So dysphagia during the oral stage or phase of the swallow can result from
altered structures or muscle tone affecting the jaw, the lips, the tongue, or the
soft palate, disrupting retention or preparation of the bolus. Sensory
impairments, such as following surgery or as a result of stroke or cognitive
difficulties, may result in failure to detect material within the mouth. Either
may result in uncontrolled material entering the pharynx and the open airway.
Controlled transfer of the bolus is essential to triggering the pharyngeal phase.
Even swallowing saliva is controlled, even though we are not conscious that we
are doing it.
Loss of sensation or neurological failure to trigger this phase will result in
absent or delayed initiation of the pharyngeal swallow. Material enters the
airway, resulting aspiration before the swallow. Incomplete closure of the vocal
cords, perhaps due to localised nerve palsy, can result in aspiration during the
swallow. Failure to clear the pharynx, for example, because of incomplete
elevation of the larynx, will result in residue remaining within the pharynx,
which can result in material spilling into the airway, causing aspiration after the
swallow.
During the oesophageal phase, loss of peristalsis, a muscular stricture, or an
obstruction, for example, by a tumour, will result in slowing or failure of
transport of bolus to the stomach. If this is very severe, it will result in
regurgitation of material into the pharynx, carrying the risk of aspiration. If
stomach content's regurgitated and aspirated, this carries the highest risk of
development of aspiration pneumonia. The normal response to aspiration is a
cough, as you will know if you've ever experienced food or drink going down
the wrong way. Some developmental or acquired neurological conditions result
in loss of sensation, which results in a weak or absent cough or even a delayed
cough.
Patients with poor respiratory status may also have a weak cough. If there is
no cough response, this is called silent aspiration. Failure of secondary

protection, i.e., the cough, will result in a significant risk of chest infection or
pneumonia.