Parkinson’s – Difficulty Swallowing (Dysphagia), Drooling & Aspiration – drkhakar

Parkinson’s disease may cause difficulty swallowing (Dysphagia). Food may go into the lungs – this is called Aspiration. The decrease in swallowing saliva may also cause drooling.

These problems are particularly severe in a disease called Progressive Supranuclear Palsy (PSP). Although PSP is slightly different than Parkinson’s disease, all the information given here is helpful if you have PSP.

Parkinson's Problems discussed in this article
1. Swallowing difficulty (Dysphagia)
2. Aspiration
3. Drooling

It is absolutely critical to recognize these problems. Aspiration in particular can cause a life-threatening bad lung infection (Aspiration Pneumonia).

Although drooling is not life thereatening, some Parkinson’s patients report that drooling is one of their most inconvenient problems.

Is difficulty swallowing (Dysphagia) common in Parkinson’s disease?


Many patients with Parkinson’s disease may complain of difficulty swallowing. The medical term for swallowing difficulty is “Dysphagia”.

In milder cases, you may just have the feeling that food gets “stuck” in your throat. Some patients may report that they have a feeling of their “throat closing” when they try to swallow.

In more severe cases, you may tend to choke on your food if you try to swallow it too quickly.



How does Parkinson’s cause Aspiration?

Our mouth connects to two pipes: The food-pipe (oesophagus) and the windpipe (trachea).

When we are swallowing, the muscles in our throat move rapidly. They close the wind-pipe and make the food-pipe bigger, so that food goes into the food pipe.

Swallowing food requires many muscles to move in a coordinated manner.

These movements become slow in Parkinson’s disease – as a result, food may go into the wind-pipe instead and end up in the Lungs. Food going into the lungs is called “Aspiration”.

The paths taken by air and food are different. Ideally, absolutely no food should go into the windpipe (trachea).


Why do Parkinson’s patients cough while swallowing food?

When a small particle of food goes into the wind-pipe, we gag & start coughing vigorously to throw the particles out. These are called the “Gag” and “Cough” reflexes.

Food can go into the wrong pipe often in Parkinson’s patients (see above). Therefore they frequently cough while swallowing food.


Gagging and coughing are protective responses to prevent food from going into the wind-pipe. These are “good” reflexes, which protect our lungs.


But the condition becomes even more problematic in advanced Parkinson’s disease.

In advanced Parkinson’s disease, there may be no coughing even when particles are entering the windpipe. This is dangerous!

Thus, particles of food may repeatedly go into the lungs of Parkinson’s patients without them noticing it. This is called “Silent Aspiration”.

Why does Parkinson’s disease cause Drooling?

Saliva is produced by small glands around our mouth, called “Salivary glands”.

Our salivary glands continuously produce saliva, even when we are not eating.

It is a common misconception that Parkinson’s patients have drooling because they are producing too much saliva. In fact, multiple studies have shown that most Parkinson’s patients produce less saliva. 

Our salivary glands continuously produce saliva, even when we are not eating.

Normally, we automatically swallow this saliva, through small gulps that we don’t even notice.

But in Parkinson’s disease, there is a marked decrease in all automatic movements, including automatic swallowing.

Therefore, saliva accumulates in the mouth. When the mouth is full, it drips out. We call this “Drooling”.


Let’s talk about treatment…


In Parkinson’s disease, how is swallowing difficulty (Dysphagia) & Aspiration treated?

If your Parkinson’s is causing dysphagia, the following things are helpful in preventing aspiration.

A. Exercises to improve swallowing difficulty (dysphagia):

A speech-swallow therapist evaluates how your muscles move while swallowing. They can teach you important exercises to improve swallowing difficulty (dysphagia) and prevent Aspiration.

Click here for an excellent video by a speech & swallow therapist:


Speech therapists specially trained in Parkinson’s can teach you exercises such as Expiratory Muscle Strength Training (EMST) or Lee Silverman Speech Therapy (LSVT) or LOUD therapy.

These specialized training sessions are tremendously helpful in improving voice. But these exercises also make swallowing easier.

Lee Silverman Speech Therapy – also called LSVT or LOUD therapy – can help you speak much more loudly and also decrease the risk of aspiration.

B. Adequate treatment with levodopa:

As described earlier, swallowing is a series of movements. These movements are slow if you have Parkinson’s disease.

In many (but not all) patients Levodopa can make these movements rapid again.

If your movement problems are adequately treated, then the movements of your swallowing muscles may also improve dramatically.

The same medications that help your body move faster also help your speech and swallowing muscles to move faster.

It is not just levodopa – any medication that improves your movements may improve dysphagia caused by Parkinson’s disease Proper movements of the lips, jaw, tongue and throat reduce difficulty swallowing & reduce the risk of aspiration.

C. Follow these tips to decrease swallowing difficulty (dysphagia) & Aspiration risk:

Although these tips are not a substitute for evaluation and training by a speech-swallow therapist, I think following these instructions will be very helpful for you.

  1. Try to avoid very hard foods: These are difficult to chew and grind. If you try to swallow larger chunks of food, you may find it difficult. For example, try to avoid hard fruits like green apples. How do you get your fibre then? Well, you can still eat these foods by putting them through an electric mixer first to make a smoothie! (Click here).
    apple 1051018 1920
    Avoid hard to chew food items, like hard fruits.
  2. Put small portions of food in your mouth: This makes it easier for you to chew and grind them up adequately.
  3. Chew food adequately: If needed, you can count the number of times that you chew your food – Chew each piece of food that you put in your mouth at least 20 times before trying to swallow it.
    breakfast 690128 1920
    Don’t put too much food into your mouth at one time.
  4. Sit upright while eating: Make gravity do your work! Sitting upright while eating helps your food pipe to dump the food into your stomach. Never have food while lying down in bed.
    picnic 2659207 1920
    Sitting upright while eating makes it easier to swallow.
  5. Make sure your mouth is empty before taking another bite: Once you think you have finished swallowing, use your tongue and move it around your mouth to make sure there are no un-swallowed masses of food in your mouth. If needed, use your finger for this purpose. It is always better to be careful.

How is drooling in Parkinson’s disease treated?

There are two things you can do to decrease drooling.

You can either reduce the amount of saliva produced, or you can increase automatic swallowing.

A. Reducing the amount of saliva produced:

Saliva can be reduced by a number of medications called “Anticholinergics”. These include medications such as Glycopyrollate, hycosamine etc.

These medications tell our salivary glands to decrease saliva production.

Some of these medications are also available in convenient packages such as skin patches. A “Scopolamine patch” is a small sticky patch applied to the skin. It gradually releases a medication called scopolamine. It needs to be replaced every 3 days.

Scopolamine patches (similar in appearancence to this nicoderm patch here) can be used to reduce saliva production in Parkinson’s disease. This reduces drooling.

Actually, I am not a big fan of these medications. Anticholinergics can produce some nasty side-effects such as confusion and urinary retention (click here to learn more). Therefore, they need to be used carefully and at the lowest dose possible.

A much better alternative is botox (botulinum toxin) injections into the salivary glands. These injections markedly decrease saliva production, reducing drooling dramatically in many cases.

Here is a link to one of the numerous research studies that have demonstrated the safety and efficacy of botox injections for excessive drooling in Parkinson’s disease [External link: Lagalla et al].

BotoxInjectionsDrooling e1607440652906
Botox injections into the salivary glands reduce drooling in Parkinson’s disease. This is a fairly quick and safe outpatient procedure.

Botox injection into the salivary glands does not cause severe pain. It can be performed within a few minutes, in the outpatient department. There is no reason to get admitted.

Since such a small dose of botox is used, and very little of the botox goes into the bloodstream, there are usually no side-effects.

The only problems are that the injections are somewhat expensive & wear off after some time. They may need to be repeated every 3-6 months.

B. Improving the swallowing of Saliva:

Drooling can also be decreased by all the techniques we have discussed before, including swallowing exercises and adequate treatment with medications.



  • Parkinson’s disease causes our swallowing muscles to become slow & move less.
  • This causes all 3 problems discussed here: difficulty swallowing (dysphagia), aspiration & drooling.
  • Difficulty swallowing (Dysphagia) should be promptly evaluated and treated to prevent Aspiration.
  • Swallowing exercises are very helpful to reduce swallowing difficulty. Simple precautions are also needed.
  • Drooling is decreased by all the measures above. In addition, oral medications, skin patches and botox injections can be used to reduce drooling in Parkinson’s disease.




Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message

NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.6 87 reviews

  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ a year ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ a year ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ a year ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ a year ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ a year ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

Leave a Comment

Noted as one of the best Neurologists in Mumbai

India Today Magazine - 2020, 2021, 2022, 2023

Outlook India Magazine - 2021, 2023

Ex-Assistant Professor, University of Alabama, USA

Outlook India - Best neurologist in Mumbai