After a laryngectomy, a swallowing evaluation performed by a speech pathologist will determine the presence and level of dysphagia, or difficulty swallowing. This difficulty can have a notable impact on eating habits, social participation, and taking part in activities that were previously enjoyed. The National Dysphagia Diet identifies food consistency and thickness of liquids that those with varying degrees of dysphagia will be able to handle.
Level 1
The National Dysphagia Diet 1, or the "pureed diet," is the most restrictive and consists of smooth, pureed and uniform foods. These foods should have a consistency and mouth-feel similar to pudding. This diet is intended for those with moderate to severe dysphagia and may require the use of a feeding tube. Patients on this diet may have minimal chewing ability.
Level 2
The level 2 diet, or the "mechanically altered" diet, dictates that foods be moist, soft-textured and easily formed into a bolus, a ready-to-be-swallowed mass of food. Meats should be ground or minced into quarter-inch or smaller pieces that are still moist and moderately cohesive. All foods from the level 1 diet are also acceptable. This diet, which requires the ability to chew, is a transition from pureed textures to more solid textures. This level is appropriate for individuals with mild to moderate oral and/or pharyngeal dysphagia. Some mixed textures may be allowed on this diet after assessment.
Level 3
Level 3 of the National Dysphagia Diet is composed of foods that are close to regular textures but excludes very hard, sticky or crunchy foods. Foods should still be moist and in bite-size pieces. This is a transitional stage to a regular diet and requires adequate chewing ability and dentition. The textures of this diet are appropriate for individuals with mild oral and/or pharyngeal phase dysphagia. In all levels, nuts, seeds, coconut, tough foods or foods with large chunks are not permitted.
Considerations
Patients should meet regularly with a registered dietitian, who can design a personalized diet based on taste preferences along with the level of dysphagia. Laryngectomy can cause changes in taste and preferences for certain foods.
References
- "Oncology Nursing Forum"; Educational Needs and Altered Eating Habits Following a Total Laryngectomy; Terry Lennie et al.; 2001
- "Journal of Dysphagia"; Post Laryngectomy: It's Hard to Swallow; Julia Maclean et al.; 2009
- "Krause's Food and Nutrition Therapy"; Sylvia Escott-Stump and L. Kathleen Mahan.; 2008
- The ASHA Leader; National Dysphagia Diet: What to Swallow?; Gary McCullough, Cathy Pelletier and Catriona Steele; November 2003
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