Chapter 1 Flashcards
What is Dysphagia?
difficulty swallowing and/or difficulty moving bolus from mouth to stomach
Is dysphagia age specific?
no, ages can range from newborn to elderly
What are some etiologies of Dysphagia?
infection, structural malformations, surgery, conditions that weaken/damage muscle/nerves
What are some examples of the types of surgeries that can lead to Dysphagia?
thyroid, RLN, cervical
What are some examples of the types of conditions that weaken/damage muscle/nerves?
CVA, parkinson’s, TBI
What are some consequences of Dysphagia?
Dehydration, malnutrition, aspiration pneumonia and overall quality of life
What is the leading cause of death in Parkinson’s?
Aspiration pneumonia
What are the types of dysphagia?
Oral, pharyngeal and esophageal
although oropharyngeal can also be mentioned when its a combination of oral and pharyngeal
The types of dysphagia correlate with the __
phases of dysphagia
What are some of examples of oral dysphagia?
tongue movement, lip closure, pocketing and transport
What are some examples of pharyngeal dysphagia?
airway closure, residues, motility and UES
What are some examples of esophageal dysphagia?
motility, LES, fistula, diverticulum, HCI-reflux, ulcer
Patients who report oropharyngeal swallowing are able to describe symptoms accurately. T/F
True
Patients with esophageal disorders may be highly inaccurate in describing their symptoms. T/F
True
Literature on deglutition or swallowing falls into three categories: _
Physiology of normal swallow, changes in physiology if swallowing as a result of a variety of medical conditions and methodologies for screening/diagnosis and management of patients with dysphagia
What is diverticulum?
pockets in esophagus
What are the stages of dysphagia?
oral, pharyngeal and esophageal
Describe the oral stage.
mastication, bolus formation, and bolus transport from the oral cavity to pharynx.
This stage begins when lips close after food enters mouth.
How long does the oral stage last?
It is dependent on the bolus
Describe the pharyngeal stage.
The epiglottis inverts over the laryngeal vestibule. The larynx and hyoid bone are pulled anteriorly and superiorly to open the pharynx, relax the cricopharyngeus (UES) muscle, and assist the vocal folds in closing off the glottis. The bolus is propelled through the pharynx toward the esophagus by action of pharyngeal constrictors.
How long is the pharyngeal phase?
about 1 second
When does the pharyngeal phase begin?
when the head of the bolus gets past the posterior faucial pillar
The majority of disorders are found in what phase of the swallow?
pharyngeal
Describe the esophageal stage.
The bolus flows through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall. Relaxation of the LES allows bolus to flow into stomach, then closes to prevent food from coming back up
The stage before lips close is called __
feeding
When doing therapy with swallowing, it is important to remember what about the oral stage?
keep it to a “normal” time limit
How long does the esophageal stage last?
8-20 seconds depending on bolus
What are some signs and symptoms of oral or pharyngeal dysphagia?
coughing or choking with swallowing difficulty initiating swallowing food sticking to the throat sialorrhea/xerostomia drooling or spillage unexplained weight loss change in dietary habits penetration aspiration recurrent pneumonia change in voice (wet gurgly voice) Nasal regurgitation tearing and/or nose running Sore throat
Spillage is defined as
premature spillage over tongue base
they will cough
What is penetration?
food or drink into laryngeal vestibule, past epiglottis
What is aspiration?
food or drink past vocal folds and into trachea
What does a wet gurgly voice indicate?
bolus on the vocal folds
Why is nasal regurgitation a symptom of oral or pharyngeal dysphagia?
VP not closing or extreme reflux
Tearing and/or runny nose can indicate
silent aspiration
What are some signs and symptoms of esophageal dysphagia?
sensation of food sticking in the chest or throat chest pain oral or pharyngeal regurgitation change in dietary habits recurrent pneumonia reflux aspiration
Head, neck and chest radiation cause the esophagus to __
narrow
Silent aspiration occurs in what stage?
pharyngeal mostly but can be have esophageal problems too
What is feeding?
placement of food in the mouth before initiation of swallow
Feeding is also called __
Oral prep stage
What is swallowing?
transfer of food/drink from mouth to stomach
What is a swallow screening?
10-15 minute administration/observation of a small bolus. It is a pre-diagnostic tool
What are the parts of a bedside clinical assessment?
medical history, level of alertness, patient interview, oral motor exam, assess swallow with small bolus
What signs and symptoms are you looking for in a screening or bedside assessment?
spillage, oral reside, long transit time, cough, throat clear, gurgly voice, tearing, runny nose, wrong auscultation
What is auscultation?
listening to the internal sounds of the body, usually using a stethoscope
ID symptoms to explain
abnormalities in anatomy or physiology causing dysphagia (etiology)
Diagnostic Procedures examine the physiology through looking at
timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis and sensitivity
Diagnostic procedures examines the immediate effects of
treatment
What are some imaging diagnostic procedures?
FEES/FEESST videofluoroscopy ultrasound videoendoscopy Scintigraphy
What are some nonimaging diagnostic procedures?
EMG, EEG, acoustic (accelerometer or stethoscope), pharyngeal manometry
What are some treatments for dysphagia?
diet modification- last resort compensatory strategies maneuver exercise stimulation experimental prosthetic surgery
Describe diet modification as a treatment for dysphagia.
change volume, viscosity, texture, temperature of food/drink NPO-NG tube G tube PEG tube J tube TPN
Describe compensatory strategies as a treatment for dysphagia.
Mostly positional like posture
chin tuck
head rotation
multiple swallows
What are some maneuver strategies as a treatment for dysphagia.
Supraglottic, Super-glottic, Mendelsohn, Effortful swallow
What are some exercise strategies as a treatment for dysphagia.
shaker, masako, oral muscle strengthening
What are some stimulation strategies as a treatment for dysphagia.
thermal/tactile stim
What are some experimental strategies as a treatment for dysphagia.
neuromuscular electrical stimulation, deep pharyngeal neuromuscular stimulation, myofascial release, botox
Who is part of the team for a patient with dysphagia?
SLP physician/ neurologist/ ENT nursing dietician OT PT Radiologist Pharmacist social worker psychologist
Why is keeping a good relationship with the pharmacist important?
because many drugs cause dysphagia
What are some examples of prosthetic treatment?
palatal lift or obturator
What are some examples of surgery treatment?
CP myotomy, diverticulectomy, dilation
