What is the prognosis of dysphagia?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Stroke patients recover swallowing function gradually, and therapeutic interventions for dysphagia generally are successful. In a prospective investigation of 128 patients admitted because of acute stroke, a swallowing abnormality was detected in 51% on clinical examination and in 64% on videofluoroscopy at initial presentation. [28] At 6 months after stroke, 87% of patients had returned to their prestroke diet.

In conditions in which recovery is possible (eg, TBI, stroke), the normalization of swallowing may take from 3 weeks to approximately 6 months or longer. [29, 1] Many patients tolerate normal oral caloric intake 9 months after a stroke, while some may require partial or nonoral caloric supplementation. In patients who have sustained a stroke, continued swallowing dysfunction after 6 months is associated with increased morbidity and mortality.

In static or progressive conditions (eg, neuromuscular disorders, postpolio syndrome), periodic evaluation of swallowing disorders is mandatory, especially with the onset of new symptoms, and the appropriate strategies (the use of nonoral feeding techniques or new compensatory mechanisms) should be considered.

Aspiration pneumonia

Pneumonia accounts for about 34% of all stroke-related deaths and represents the third highest cause of death during the first month after a stroke. Although not all of these cases of pneumonia are attributable to the aspiration of food, the early detection and treatment of dysphagia in patients who have sustained a stroke is nonetheless very critical. [30]

In a study of 124 patients with acute stroke, 39% of them had failing results on initial swallow screening. [31] However, because of early management (eg, altered dietary texture) of their dysphagia, no patients developed aspiration pneumonia. Early swallow screening and dysphagia management in patients with acute stroke reduces their risk of aspiration pneumonia, is cost effective, and helps to ensure good-quality care with optimal outcomes.

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