Bolus Flow & Physiological Correlations

Question 1

What are some symptoms of impaired bolus preparation/oral stage? (4)

Answer 1

1) Prolonged mastication - due to difficulty breaking down bolus or cognitive impairment (I.e., Dementia)
2) Prolonged oral transit time
3) Premature spillage of bolus either anteriorly or posteriorly.
4) Oral residue

Question 2

What are some symptoms of delayed swallow initiation? (2)

Answer 2

1) Premature posterior spillage of bolus before patient actually wants to swallow.
2) Penetration/aspiration before the swallow.

Question 3

What are some symptoms of BOT retraction? (1)

Answer 3

1) Residue in valleculae

Question 4

What are some symptoms of impaired UES opening, hyoid excursion? (2)

Answer 4

1) Residue in the pyriform sinuses, which could lead to penetration/aspiration after the swallow.
2) Penetration/aspiration DURING the swallow.

Question 5

What are some symptoms of impaired pharyngeal constriction? (2)

Answer 5

1) Diffuse pharyngeal residue.

2) Prolonged pharyngeal transit time.

Question 6

What are some symptoms of impaired epiglottic deflection? (1)

Answer 6

1) Penetration/aspiration during the swallow.

Question 7

What should you treat if aspiration happens BEFORE the swallow?

Answer 7

Swallow initiating aspects.

Question 8

What should you treat if aspiration occurs DURING the swallow?

Answer 8

Airway protection issues

Question 9

What should you treat if aspiration occurs AFTER the swallow? (3)

Answer 9

Depends on where the residue came from:

1) Valleculae —> BOT retraction
2) UES —> UES opening or hyolaryngeal excursion
3) Diffuse pharyngeal area —> pharyngeal constriction

Question 10

Spillage is indicative of an impairment in which stage?

Answer 10

Oral stage (both posterior and anterior spillage).

Question 11

How do you tell the difference between spillage and pooling?

Answer 11

Spillage occurs before the bolus is created, during mastication and oral transit.

If the bolus is already created and being transported to the faucial arches and begins to go down the pharynx without a swallow initiated, then it is pooling.

Question 12

Prolonged mastication is an impairment indicative to which phase of the swallow?

Answer 12

Oral prep

Question 13

Oral residue is a sign that _____ phase of swallow is impaired.

Answer 13

Oral prep

Question 14

Pre-what might be the physiology behind pre-swallow pooling of bolus in the pyriform sinuses?

Answer 14

Delayed swallow initiation

Question 15

What does it mean for a swallow to be safe? (2)

Answer 15

1) Airway is protected

2) no penetration/aspiration occurs

Question 16

A swallow has to be _____ and ______.

Answer 16

Safe & Efficient

Question 17

What does it mean for a swallow to be efficient? (2)

Answer 17

1) Bolus is completely cleared.

2) No oral or pharyngeal residue.

Question 18

What are some symptoms of delayed swallow initiation? (2)

Answer 18

1) Pre-swallow pooling (bolus falls back into pharynx before person actually wants to swallow).
2) Penetration/aspiration BEFORE the swallow