Exploring the effectiveness of pharyngeal stimulation in rewiring swallowing mechanisms for patients with dysphagia: A case report

Amirthavarshini*

Speech therapist, Kauvery Hospital, Radial Road, Chennai, Tamil Nadu

*Correspondence

Introduction

Pharyngeal stimulation is a therapeutic technique aimed at enhancing the swallowing function in individuals suffering from dysphagia due to neurological impairments or structural abnormalities. Dysphagia, characterized by difficulty in swallowing, can significantly impact a patient’s quality of life, leading to dependency on enteral feeding, malnutrition, and psychosocial distress. The goal of pharyngeal stimulation is to rewire the swallowing reflex through targeted sensory and motor rehabilitation, leveraging neuroplasticity to restore functional swallowing.

This case report examines a patient who underwent pharyngeal stimulation therapy following recurrent ischemic strokes resulting in dysphagia. The therapy demonstrated tangible improvements in swallowing function, food intake time, and overall quality of life.

Case presentation

Patient history

  • Age & Gender: 58 years, Male
  • Primary complaint: Difficulty swallowing and pain in the throat region.

Medical history

  • Recurrent ischemic strokes, with acute infarct in the lateral aspect of the medulla (right side).
  • Old lacunar infarcts in the left caudate nucleus, left corona radiata, and small vessel ischemic changes in the bilateral centrum semiovale.
  • Slurred speech and superficial sensory impairment in the left upper and lower limbs (occasional).

Date of Admission: 18 April 2026.

Initial Management: Conservative treatment with an NG tube inserted on 1 May 2026 for feeding due to severe dysphagia.

Symptoms at presentation

  • Cough and chest pain while swallowing water.
  • Dependency on NG tube feeding.

Intervention: Pharyngeal stimulation therapy

Pharyngeal stimulation therapy was initiated as part of the rehabilitation program at Kauvery Hospital. The therapy focused on rewiring the patient’s swallowing mechanism through sensory stimulation techniques tailored to individual needs.

Key aspects of the intervention included

Swallowing Evaluation: Swallowing evaluation takes in mind of many aspects such as

Oral Peripheral Mechanism Examination: Evaluating aspect of oral structures such as tongue, lips, palate and uvula.

Sensory perception in superficial and deep sensation.

Swallowing profile:  Assessment using semi-solid and liquid consistencies. In which we assess the time of swallowing, sign of aspiration and penetration such as delay in swallowing, multiple swallowing, cough, throat clearing during swallowing and after swallowing and voice changes in swallowing.

Management of Swallowing

Compensatory strategies:

  • Head positioning: Adjustments to head position to the weaker side to effectively swallow.
  • Effortful Swallow: Push your tongue hard against the roof of your mouth and swallow with extra muscle effort, as if swallowing a large piece of food.
  • Mendelsohn manoeuvre: Feel your Adam’s apple rise during a swallow, then hold it at the highest point for a few seconds before finishing the swallow.

Pharyngeal strengthening

  • Shaker Exercise: Lie flat on your back, lift your head to look at your toes while keeping your shoulders flat on the floor, and hold or repeat as directed.
  • Phonation exercises: Take a deep breath and phonate /a/, /i/ & /u/ sounds.
  • Phonation exercises & Head positioning: Changing head positioning and repating phonation exercises.

Texture introduction: Gradual introduction of different food textures to train tolerance and swallowing reflex.

Pharyngeal stimulation

Pharyngeal stimulation was given Variable Muscle Stimulation (VMS) protocol.

Clinical ParameterBaseline statusWeek 1Week 2Week 3Week 4 outcomeClinical Significance
AmplitudeRight side - 12 Micro amp.
Left side - 5 Micro amp.		Right side - 10 Micro amp.
Left side - 5 Micro amp.		Right side - 8 Micro amp.
Left side - 5 Micro amp.		Right side - 6 Micro amp.
Left side - 5 Micro amp.		Right side - 6 Micro amp.
Left side - 5 Micro amp.		Stimulation and coordination between muscles
Stimulation duration15 sec10 sec8 sec5 sec5 secReduction in swallowing delay
Stimulation typeUnilateralUnilateralUnilateralBilateralBilateralCoordination between both sides
Textures givenCustardSemisolidsSoft solidsTextured foods & liquidsHard foods & Pill swallowingTo achieve complete independence in eating

Counselling sessions: Three counselling sessions were conducted to educate the patient and caregivers about swallowing techniques and to deal with fear of aspiration and to encourage patient to move to next food texture independently

 

Outcomes and progress

Clinical progress during rehabilitation

The patient underwent structured pharyngeal stimulation therapy over a four-week rehabilitation period. Progress was monitored continuously through bedside swallowing assessments, observation of compensatory swallowing patterns, respiratory safety, and oral intake tolerance.

Initially, the patient demonstrated significant swallowing difficulty following recurrent cerebrovascular accidents involving the lateral medulla. The neurological insult disrupted the coordination between the sensory and motor components of swallowing, resulting in impaired bolus propulsion and increased discomfort during oral intake. At admission, swallowing even small quantities of water triggered coughing and chest discomfort, indicating poor airway protection and reduced pharyngeal coordination. Because of the severity of dysphagia, the patient required nasogastric tube feeding to maintain nutritional status safely.

During the early phase of therapy, the primary goal was to stimulate the sensory receptors of the pharynx and improve neuromuscular responsiveness. Controlled sensory stimulation combined with positional modifications helped facilitate initiation of the swallowing reflex. Semi-solid consistencies were introduced first because they provide better bolus control and reduce aspiration risk compared to thin liquids.

Pharyngeal stimulation outcome

Clinical ParameterBaseline statusWeek 4 outcomeClinical Significance
AMP Required to stimulateRight side - 12 Micro amp.
Left side - 5 Micro amp.		Right side - 6 Micro amp.
Left side - 5 Micro amp.		Bring both side muscular activation level to normal
Duration of stimulation to make effortful swallowing15 sec5 secReduced swallowing delay

As therapy progressed, the patient gradually demonstrated:

  • Improved oral control and bolus transit.
  • Better coordination between swallowing and breathing.
  • Better coordination in bilateral pharyngeal moment
  • Reducing swallowing delay
  • Reduced effort during swallowing.
  • Increased tolerance to different food textures.
  • Improved confidence during oral intake.

One of the most clinically significant observations was the disappearance of multiple swallowing attempts. Initially, the patient required repeated swallows to clear a single bolus, suggesting inefficient pharyngeal clearance. By the fourth week, this compensatory behavior was absent, indicating improved pharyngeal muscle coordination and stronger swallow efficiency.

Another notable improvement was the complete resolution of coughing episodes during feeding. In dysphagia rehabilitation, reduction of cough is an important marker because persistent cough often reflects airway compromise or penetration risk. The absence of cough, combined with the lack of aspiration signs, suggested that the patient regained safer swallowing mechanics.

Quantitative and functional outcomes

Clinical ParameterBaseline statusWeek 4 outcomeClinical Significance
Feeding MethodNG tube dependentFull oral feedingRestoration of oral intake
Food Intake Duration1 hour 15 minutes30 minutesImproved swallow efficiency
Weight 50 kg 56 kg Signifies improved oral intake
Multiple SwallowingPresentAbsentBetter pharyngeal clearance
Cough During SwallowOccasionalAbsentImproved airway protection
AspirationNot observed but high riskAbsentSafer swallowing function
Penetration SignsAbsentAbsentMaintained laryngeal safety
Tolerance to ConsistenciesLimitedTolerated all consistenciesFunctional swallowing recovery
Nutritional IndependenceDependent on tube feedingIndependent oral intakeImproved quality of life

Functional recovery and quality of life impact

The improvement extended beyond clinical swallowing parameters. Functional recovery was evident in the patient’s nutritional independence, social interaction, and psychological well-being.

Before therapy, meals were prolonged, exhausting, and associated with anxiety due to fear of choking. Dependence on tube feeding also affected the patient’s autonomy and emotional state. Following rehabilitation:

  • Meal times became shorter and less fatiguing.
  • The patient resumed oral feeding comfortably.
  • Confidence during eating improved significantly.
  • Dependency on enteral feeding was eliminated.
  • Overall quality of life improved.

This transition from assisted feeding to independent oral intake represents a major rehabilitation milestone in dysphagia management. In neurological patients, restoring safe swallowing often reduces hospital stay duration, lowers aspiration pneumonia risk, and improves long-term rehabilitation outcomes.

 

Clinical interpretation

The patient’s progress strongly supports the therapeutic value of pharyngeal stimulation in neurogenic dysphagia rehabilitation. The intervention appeared to enhance sensory input to the swallowing centres and improve neuromuscular coordination through repetitive stimulation and task-specific training.

The part many teams underestimate is that swallowing recovery is not just muscle strengthening – it is sensory retraining. In lateral medullary involvement, patients often lose the sensory trigger that initiates an effective swallow. Pharyngeal stimulation helps “reawaken” these pathways, allowing the brainstem swallowing centres to reorganize and function more efficiently through neuroplastic adaptation.

At Kauvery Hospital, this type of structured dysphagia rehabilitation can significantly reduce prolonged NG tube dependency, improve patient satisfaction, and potentially decrease aspiration-related complications in post-stroke patients.

Overall outcome

By the end of four weeks:

  • The patient achieved functional swallowing recovery.
  • Oral feeding was restored safely.
  • No aspiration or penetration signs were observed.
  • Swallow efficiency improved substantially.
  • The patient regained nutritional independence and improved quality of life.

The case highlights the importance of early dysphagia rehabilitation and demonstrates how targeted pharyngeal stimulation can contribute to meaningful neurological and functional recovery.

Discussion

Mechanism of pharyngeal stimulation

Pharyngeal stimulation works by activating sensory pathways in the pharynx, which in turn stimulate motor reflexes responsible for swallowing. This therapy leverages neuroplasticity, encouraging the brain to adapt and reorganize its control over impaired swallowing reflexes. Specific techniques include:

  • Controlled exposure to various textures and consistencies.
  • Sensory stimulation targeting the pharyngeal mucosa.
  • Gradual desensitization to avoid gag reflex and promote smoother swallowing.

Clinical significance

This case demonstrates the effectiveness of pharyngeal stimulation in managing dysphagia due to neurological impairments. Key outcomes include:

  • Restoration of functional swallowing without aspiration risk.
  • Reduction in food intake time, improving nutritional status and patient autonomy.
  • Enhanced psychosocial well-being through the elimination of tube dependency.

Recommendations

  • Early Assessment: Conduct swallowing evaluations immediately post-CVA to identify candidates for pharyngeal stimulation.
  • Tailored Therapy: Customize stimulation protocols based on patient-specific swallowing profiles and sensory impairments.
  • Interdisciplinary Approach: Collaborate with speech therapists, neurologists, and dieticians to optimize rehabilitation.
  • Family Education: Provide caregivers with training on safe feeding practices and positional modifications.

Conclusion

Pharyngeal stimulation has emerged as a promising intervention for dysphagia rehabilitation. This case report highlights its potential to restore swallowing function and improve the quality of life for patients with neurological impairments. Early initiation and individualized therapy plans are critical to achieving optimal outcomes.

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