Dysphagia Flashcards
Contrast aspiration and penetration.
entry of material below the level of the true vocal folds into the trachea, penetration occurs when the material does not descend below the vocal folds into the trachea
Who is at risk for dysphagia?
premature infants, children with cerebral palsy and head injury, aging adults
Oropharyngeal stage includes which areas of anatomy?
mouth, pharynx, larynx
esophageal phase includes the esophagus
Describe the neuronal output that controls swallowing.
a large scale distributed swallowing neural network carries out a patterned response (not a traditional reflex- includes cortex modulation)
input form frontal cortex and dorsal region with the nucleus of the the tracts solitaires and the ventral region around the nucleus ambiguus
Describe the “two pump system” during the oral phase of swallowing.
oropharyngeal propulsive pump: lingal and velopharyngeal dynamics cause positive pressure
hypophyarngeal suction pump: hyolaryngeal excursion up and forward opens the UES and cause sub atmospheric pressure
Contrast the role of intrinsic and extrinsic muscles in the oral transport phase.
intrinsic muscles work to contain bolus and the extrinsic muscle transport the bolus
What occurs during the pharyngeal phase of swallowing?
- velopharyngeal closure
- backward thrusting of the tongue base to the pharyngeal wall
- elevation and forward movement of the hyoid bone
- laryngeal closure, UES relaxation and opening
What occurs during the esophageal phase of swallowing?
bolus is moved from the UES through LES and into the stomach by gravity and peristalsis
List different broad categories of adult dysphagia based on etiology. (6)
neurogenic (i.e. stroke) immunologic (i.e. Sjorgen's) iatrogenic (i.e. medication, chemo side effect) obstructive (i.e. tumor) psychiatric (i.e. dementia) general reconditioning
What might be on your differential with a hospitalized patient with wet/gurgly voice, SOB and fever?
wet gurgle voice can be a sign of silent aspiration which can lead to aspiration pneumonia
silent aspiration can occur with interruption of nerve innervation or severely impaired cognition
(accounts for 35% of stroke deaths)
List some symptoms of oropharyngeal dysphagia.
drooling residue in mouth difficulty chewing choking lump in throat sensation leaving food on plate changes in eating habits weight loss
coughing during or after meals throat clearing increased secretions wet/gurgly voice fever chest sounds reduced oral intake
Name 6 situation in which a doctor should order a swallow consult.
dx of new stroke, head/neck injury or cancer modified texture of food inability to follow commands wet/gurgly voice drooling while awake tongue deviation from midline (weakness)
What is involved in the bedside swallow evaluation?
take history and observe patient
four finger palpation to sense timing of swallowing (admin liquid and food)
(can’t rule out aspiration with adequate level of confidence)
What tests are available for instrumental evaluation of dysphagia?
radiography: modified barium swallow or esophagram (videofluroscopy)
manometry
ultrasound
the key is ID of etiology for the dysphagia/aspiration to target appropriate treatment
When would you opt for fiberoptic endoscopic evaluation for swallowing?
to evaluate anatomy and function of nasopharynx, pharynx and larynx by direct observation
can test sensitivity (sensation)
can be used for biofeedback training
**difficult to visualize the pharyngeal phase during swallowing due to visual obstruction
