Dysphagia Severity Calculator
Assess dysphagia severity through clinical criteria and identify aspiration risk.
Important Medical Disclaimer
This calculator is an educational and clinical decision support tool. Results DO NOT replace professional medical evaluation, laboratory tests, or clinical judgment. Always consult a qualified healthcare professional for diagnosis, treatment, and clinical decisions. Calculations are based on scientifically validated formulas but may not be applicable to all patients.
Dysphagia Assessment
Note: This tool is a screening aid. Complete clinical assessment by a speech-language pathologist is essential for diagnosis and treatment.
What is Dysphagia?
Dysphagia is difficulty swallowing. It can affect any phase of swallowing: oral (mouth), pharyngeal (throat), or esophageal. It is common in elderly patients, neurological patients (stroke, Parkinson's disease, dementia), oncology patients (head and neck cancer), and degenerative diseases. Dysphagia increases the risk of aspiration (food/liquid entering the airway), aspiration pneumonia, malnutrition, and dehydration. Early recognition is fundamental to prevent serious complications and improve quality of life.
Scoring System
Total Score: 0-12
- 0: Normal - No signs of dysphagia
- 1-3: Mild - Texture modification may be needed
- 4-6: Moderate - Regular speech-language follow-up
- 7-12: Severe - High aspiration risk, urgent assessment
Frequently Asked Questions
What are the warning signs of dysphagia?
Main signs: coughing or choking during or after eating, feeling of food stuck in throat, need for multiple swallows to clear mouth, food/liquid escaping from mouth or nose, voice change after swallowing ('wet' or hoarse voice), recurrent pneumonia, unintentional weight loss, prolonged meal time (>30min), food refusal, and progressive difficulty with different textures.
What is the difference between oral, pharyngeal, and esophageal dysphagia?
Oral dysphagia: difficulty forming food bolus and initiating swallowing (tongue, lip, cheek weakness). Common in neuromuscular diseases. Pharyngeal dysphagia: difficulty in the involuntary swallowing phase, with aspiration risk (food entering airway). Common post-stroke, Parkinson's, ALS. Esophageal dysphagia: difficulty passing through esophagus (stricture, achalasia, severe reflux). Patient feels food 'stuck' in chest. Each type requires specific approach.
What is silent aspiration?
Silent aspiration occurs when food or liquid enters the airway (trachea/lungs) WITHOUT triggering cough reflex. It is very dangerous because it goes unnoticed. Common in patients with sensory deficit (post-stroke, advanced dementia). Indirect signs: recurrent pneumonia, fever without apparent cause, increased pulmonary secretions, fluctuating oxygen saturation after eating. Diagnosis by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing (FEES). Requires diet modification and compensatory techniques.
When is instrumental assessment (videofluoroscopy/FEES) necessary?
Indications: Suspected aspiration (especially silent), severe dysphagia with nutritional risk, post-stroke or cervical trauma dysphagia, failure to progress with diet modification, decannulation candidates (tracheostomy removal), before allowing oral intake in patients with alternative route (tube/gastrostomy), and when clinical assessment is inconclusive. Videofluoroscopy shows anatomy and physiology in real-time with X-ray. FEES uses nasal endoscope and doesn't use radiation, good for bedside.
What are texture modifications for dysphagia?
IDDSI Classification (International Dysphagia Diet Standardisation Initiative): Liquids - Thin, Slightly Thick, Mildly Thick, Moderately Thick, Extremely Thick. Solids - Regular, Easy to Chew, Soft & Bite-Sized, Minced & Moist, Pureed. Goal: Reduce flow speed (liquids) or facilitate chewing (solids) to give patient time to swallow safely. Commercial thickener is used for liquids. IMPORTANT: Modification must be prescribed by speech-language pathologist/dietitian, as excessive restriction can cause dehydration/malnutrition.
When to indicate alternative feeding route (tube/gastrostomy)?
Indications: Severe dysphagia with high aspiration risk and recurrent broncho-aspiration, inability to maintain adequate oral hydration/nutrition (weight loss >10%, dehydration), documented silent aspiration that doesn't improve with modifications, unconscious patients or prolonged altered consciousness, mechanical obstruction (tumor, severe stricture), and prediction of prolonged dysphagia (>4-6 weeks). Nasoenteral tube: short-term (<4 weeks). Gastrostomy (PEG): long-term. Alternative route doesn't prevent continued speech-language rehabilitation.
Scientific References
- 1. O'Neil KH, Purdy M, Falk J, Gallo L. The Dysphagia Outcome and Severity Scale. Dysphagia. 1999;14(3):139-145.
- 2. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516-1520.
- 3. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756-2763.