1. Difficulties in eating and swallowing are very common in patients with PSP, and some appear very early. The main reasons for this are as follows: (1) Being able to see food is important for eating, which requires hand-eye coordination, and patients with PSP have difficulty with this action due to limited downward vision of the eyes. (2) Patients with PSP also exhibit behavioral abnormalities, such as stuffing food into the mouth too much or drinking too quickly, which can lead to aspiration (into the lungs). (3) The fine control and coordination of chewing and swallowing muscles are easily impaired in patients with PSP. These causes lead to choking on food, weight loss, dehydration, lung infection or pneumonia. Signs that indicate the presence of swallowing problems include: (1) coughing when eating or drinking; (2) taking a long time to eat; (3) food stuck in the throat; (4) watery sound in the mouth; (5) food residues present in the mouth that take a long time to swallow; (6) sputum in the throat that cannot be easily cleared; (7) weight loss; (8) recurrent lung infections 3. PSP patients can clearly know they have swallowing problems, some do not, so they eat too much or too fast, resulting in choking and coughing. Sometimes the aspiration of food into the airway is not accompanied by coughing, which is called “insidious aspiration”. If any of these conditions exist, you need to seek medical attention. There are some simple changes that may reduce the difficulty in eating and drinking, such as: (1) Putting too much food in the mouth or drinking too quickly; watching the patient throughout the meal; frequent verbal reminders to swallow the food in the mouth and to hold the right amount of food (with a small spoon); taking small sips of water and swallowing promptly; and using a nozzle cup with a thin spout to help control the amount of water given each time. (2) Spillage of food or water onto body or clothing Raise the height of the dishes to near eye level to reduce the need for downward vision, e.g., use a height-adjustable table or plate. (3) Difficulty in expelling sputum Reduce daily intake of dairy products, which tend to make secretions sticky; use lemonade or orange juice; citrus juices dilute secretions and make them easy to swallow; nebulized inhalation can also dilute sputum. (4) Strenuous, slow and difficult swallowing Avoid foods that require more chewing and eat soft, moist foods such as stewed meat, tender chicken or fish. (5) Food stuck in the throat Avoid eating dry, crunchy foods; add soupy foods; alternate eating and water intake. (6) Difficulty swallowing medicine Take one pill at a time; put the pill in a spoonful of yogurt or porridge. When swallowing difficulties are severe enough to prevent adequate nutrition, dehydration, and/or to reduce the risk of pulmonary infection, it is necessary to consider receiving nutritional supplementation through a percutaneous gastrostomy (PEG), a form of nutritional support in which a tube is inserted directly into the stomach. If the patient is able to eat safely, he or she can still eat small amounts via the mouth after receiving PEG, but PEG can relieve the pressure to reach nutritional and fluid supplementation via the mouth. Whether or not to take this approach varies from person to person, and the pros and cons of the operation need to be discussed in detail before deciding, taking into account the opinions of the patient, family, caregiver and physician. 4. Management of difficulty in swallowing saliva Even with the placement of PEG, patients still have difficulty swallowing saliva, which can easily lead to a heavier cough at night. Normal people swallow salivary secretions several times per minute, but PSP patients swallow significantly less frequently, resulting in sticky saliva. If saliva is thin, as in occasional coughing, or does not sound loud, the following can be done: (1) Oral amitriptyline, or salivary gland botulinum toxin injections; (2) Avoid lying flat at night to avoid saliva flowing into the airway. One or two additional pillows may be added. If sputum is thick and sputum sounds are loud, medications to reduce sputum production are not appropriate and the following should be used: (1) Nebulized inhalation to dilute sputum. If the patient has access to water via the mouth, use warm lemon water; (2) Reduce dairy intake.