Can dysphagia (difficulty swallowing) cause cough?

Dysphagia Can Cause Cough

Yes, dysphagia (difficulty swallowing) commonly causes cough, particularly when aspiration occurs as food, liquid, or saliva enters the airway. 1, 2 Cough serves as a protective reflex mechanism when material penetrates or aspirates into the laryngeal area during swallowing dysfunction.

Mechanism of Dysphagia-Related Cough

• Protective reflex: Cough is an important protective mechanism that helps clear foreign material from the airways when swallowing is impaired 1
• Aspiration trigger: When food, liquid, or saliva enters the laryngeal area (penetration) or passes below the true vocal folds into the trachea (aspiration), it triggers the cough reflex 1
• Warning sign: Coughing during or after eating is a critical clinical indicator of possible aspiration due to dysphagia 2

Clinical Presentation

Common symptoms indicating dysphagia-related cough:

• Coughing or throat clearing during or immediately after eating/drinking 1, 2
• "Wet" or "gurgly" voice quality after swallowing 1
• Coughing at the end of meals, even without obvious swallowing difficulties 2
• Choking sensation when consuming food or liquids 3

Important caveat - Silent aspiration:

• Silent aspiration occurs in up to 55% of cases where aspiration happens without triggering cough 2
• This occurs due to:
  • Reduced laryngeal sensitivity
  • Impaired cough reflex (hypotussia)
  • Neurological conditions affecting sensory pathways 4

Diagnostic Considerations

When a patient presents with cough that may be related to dysphagia:

1. Obtain targeted history: Ask specifically about:

   • Timing of cough in relation to eating/drinking
   • Types of foods/liquids that trigger cough
   • Associated symptoms (choking, wet voice, throat clearing)

2. Consider risk factors for dysphagia-related cough:

   • Neurological conditions (stroke, Parkinson's disease, dementia) 1, 5
   • History of head/neck cancer or surgery 2
   • Advanced age 2
   • Recent cervical spine surgery 1

3. Diagnostic testing when dysphagia-related cough is suspected:

   • Videofluoroscopic swallow evaluation (VSE) - gold standard 1
   • Fiberoptic endoscopic evaluation of swallowing (FEES) 1
   • Basic swallow screening with 3 oz water test 2
   • Chest radiograph to identify aspiration-related changes 2

Management Approach

For patients with cough related to dysphagia:

1. Prompt referral to a speech-language pathologist (SLP) for comprehensive swallowing evaluation 2

2. Implement compensatory strategies based on instrumental swallowing studies:

   • Postural changes during swallowing
   • Modified food consistencies
   • Enhanced sensory input before swallowing 2

3. Consider rehabilitative approaches:

   • Swallowing exercises to strengthen muscles involved in swallowing
   • Techniques to improve cough effectiveness 4

4. Multidisciplinary management involving:

   • Speech-language pathologist
   • Dietitian
   • Physician
   • Nursing staff 2

Complications of Untreated Dysphagia-Related Cough

• Aspiration pneumonia (mortality rates 20-65%) 1
• Malnutrition and dehydration 6
• Chronic respiratory infections 4
• Reduced quality of life 2

Key Clinical Pearls

• Patient and caregiver reports of cough during eating are valuable diagnostic indicators (sensitivity 74%, specificity 74%) 1, 2
• The combination of reflexive cough and wet voice after swallowing increases sensitivity to 86% for detecting aspiration 2
• Many patients with dysphagia are unaware of their swallowing dysfunction, making careful observation for cough during meals essential 2
• Oropharyngeal dysphagia is highly prevalent (up to 50% of elderly people and 50% of patients with neurological conditions) but often underdiagnosed 7

In summary, cough is a common and important symptom of dysphagia that should prompt thorough evaluation, as it indicates potential aspiration that can lead to serious complications if not properly managed.