How common are swallowing problems in a general adult population?
Reviewed by Roganie Govender

This paper reports on the largest cross-continent study to date, looking at the prevalence of swallowing problems reported by adults in the community aged 18-65 years old. The authors used the Eating Assessment Tool (EAT-10) distributed via an online survey to non-selected participants across North and South America, Australasia, Europe and Africa. Of the 2022 responses available for analysis, 337 (17%) scored three and above on the EAT-10 tool, suggesting the presence of ‘pathological’ findings or dysphagia. Of note, the authors highlight three categories of interest from this survey:
1. Scored below the cut-off but expressed considerable concern about their swallow, and/or with features not captured in the survey;
2. Scored above the cut-off and reported no disease; and
3. Scored above the cut-off, reported no disease, and stated in the free text that they had no swallow problems.
The authors present an excellent discussion around the many issues and complexities in how dysphagia is assessed and/or perceived and the disconnect that sometimes exists between clinician assessment and patient perceptions. Group 1 for example, reported concerns that the survey did not capture and, whilst they had no clear diagnosis, they appeared to have noteworthy concerns around their swallow function. Groups 2 and 3, on the other hand, reported high scores on the screening tool, but reported no perceived problems swallowing. What are the implications for supporting individuals in the community who present with concerns and yet fail to reach professionals for help? The experience of the pandemic has highlighted that, due to the close interplay between respiration and swallow, many individuals with COVID-19 may present with ongoing swallow symptoms. Whilst it is important not to ‘medicalise’ normal variation in swallowing, it is also important not to underestimate the scale of the problem that may be latent in people who do present with a clear diagnosis. The implications for future work are also discussed in this paper. This is a very useful reference paper.

Is Dysphagia Under Diagnosed or is Normal Swallowing More Variable than We Think? Reported Swallowing Problems in People Aged 18–65 Years.
Leslie P & Smithard DG.
DYSPHAGIA
2021;36(5):910-8.