Dysphagia

Question 1

The four stages of swallowing?

Answer 1

Preparatory stage
Oral stage
Pharyngeal stage
Esophageal stage

Question 2

How many muscles are involved with swallowing?

Answer 2

35

Question 3

What are some risk factors for dysphasia?

Answer 3

Age 70 +
Neck Hyperextension/ kyphosis
Altered Mentation
Suboptimal Positioning 
Dysphonia/ Aphonia
Pulmonary Disease
Neurological Disorder/ Disease
Xerostomia
Poor Dentition
Deconditioning
History Dysphagia (pharyngeal or esophageal)
GERD
History XRT to chest/ neck/ face
History fibrosis in chest/ neck (from prior surgeries/ treatments/ disease)
Prolonged Intubation/ Proximity to extubation
Thoracic Surgery
Tracheostomy

Question 4

What occurs during the oral phase of swallowing?

Answer 4

Anticipation of bolus/ preparedness
Acceptance of bolus
Containment/ Oral control
Rotary Mastication
Lingual transfer to base of tongue

Question 5

What occurs during the pharyngeal phase of swallowing?

Answer 5

Initiation of swallow reflex
Occurs in < 1 second during a period of apnea lasting 0.3-2.5 seconds
Expiratory resistance provided by vocal folds to maintain lung inflation during expiratory phase

Question 6

What is a MBS/VFSS? Limitations & Advantages?

Answer 6

Modified Barium Swallow/ Videoflouroscopic Swallow Study

• Performed in the radiology department
• Performed by SLP & radiologist
• Recorded
• Reviewed

Limitations: Pt must be able to travel, takes RN off unit, pt must drink Barium, minimal info regarding soft tissue injury and larynx (may be able to identify vocal fold dysfunction to a degree), either fully upright or supine on table

Advantages: Information about all three phases of swallowing, less likely to miss silent aspiration during the swallow

Question 7

What is a FEES? Limitations & Advantages?

Answer 7

Fiberoptic Endoscopic Evaluation of Swallowing

• SLP utilizes a nasopharyngeal laryngoscope
• Recorded
• Reviewed
• Requires consent

Limitations: can be somewhat uncomfortable, we do not use topical anesthetics, can not be done on patients with certain anatomical changes, can cause nosebleed, can cause laryngospasm, cannot see the moment of swallow due to whiteout

Advantages: can be done bedside, utilizes food and liquids rather than Barium, can see soft tissue changes/ anomalies

Question 8

Signs & Symptoms of esophageal dysphagia?

Answer 8

Globus/ stasis
Pain
Belching
Regurgitation of undigested material

Question 9

Possible Etiologies of esophageal dysphagia?

Answer 9

Zenker’s
UES dysfunction
Stricture
Dysmotility
Esophagitis