Dysphagia Exam

Question 1

V Trigeminal deficit potential implications

Answer 1

MOTOR
Inadequate bolus breakdown and impaired preparation/cohesive bolus formation

Reduced anterior hyoid movement with consequent
- Decreased epiglottic deflection
- Intra-swallow penetration/aspiration
secondary to impaired supraglottic closure

                 - Vallecular residue with post swallow p.

Decreased UES opening resulting in
-Pyriform sinus residual and potential post swallow aspiration

SENSORY
Decreased bolus recognition/awareness with consequent inadequate bolus preparation and formation and post swallow residue

Delayed pharyngeal response and consequent pre swallow or intra-swallow penetration

Question 2

VII Facial deficit potential implications

Answer 2

MOTOR
Reduced elevation of hyoid
- Decreased pharyngeal shortening

Decreased salivation
- Impaired bolus formation

Base of tongue to posterior pharyngeal wall approximation
- Vallecular residue with post swallow p/a
- Pharyngeal residue

Reduced superior, posterior movement of tongue, hyoid and larynx
- reduced oral containment
-pre swallow pooling, pre swallow a/p

SENSORY

Decreased bolus recognition

Contribution to delayed pharyngeal response with consequent pre swallow or intra swallow penetration/aspiration

Question 3

IX glossopharyngeal deficit potential implications

Answer 3

MOTOR
Reduced pharyngeal shortening
- Post swallow diffuse residual
- post swallow a/p

Less likely reduced supraglottic compression
-intra swallow a/p

SENSORY
Contribution to delayed pharyngeal swallow
-pre swallow pooling
- pre swallow a/p

Question 4

X Vagus deficit potential implications

Answer 4

MOTOR
Reduced glottic closure
-intra swallow a/p
- inability to clear aspirate

Reduced UES opening in width or duration
- Pyriform sinus residue
- post a/p

SENSORY
Reduced laryngeal and tracheal sensation
-Silent aspiration

Reduced distal pharyngeal sensation
- failure to elicit clearing response

Question 5

PP deficit potential implications

Answer 5

MOTOR
Decreased supraglottic compression
-intra a/p

Decreased pharyngeal shortening + contraction
-diffuse pharyngeal residue
-post a/p

SENSORY
Reduced distal pharyngeal sensation
-failure to elicit clearing response for residue

Question 6

XII hypoglossal deficit potential implications

Answer 6

MOTOR
Reduced bolus manipulation, preparation and formation
-lack of cohsive bolus for transfer
- Post swallow oral residue
- post swallow a/p of residue

Reduced base of tongue drop
- Contribution to delayed onset of swallow with pre a/p

Decreased BoT to PPW approximation
-Superior pharyngeal residue/vallecular residue with post a/p

Question 7

Why might one see oral inefficiency but no CN XII impairment?

Answer 7

In this case, the primary etiology may be cognitive inattention

Question 8

How to determine if pre-swallow pooling is due to poor orolingual bolus control or delayed pharyngeal swallowing?

Answer 8

• Is there glossopalatal seal?
• Are there bit of unchewed bolus?
• Is there a drop push of the tongue?
• What consistancy is pooling most pronounced? (heavier = orolingual) (liquid = sensory)

Question 9

What may be the cause of bolus in the nasal cavity?

Answer 9

Issue with velopharyngeal closure (levator veli palatini) or issue with the pressure systems/timing

Question 10

Oral phase dysphagia

Answer 10

The patient presents with oral phase dysphagia characterised by poor orolingual control resulting in

• Inadequate bolus preparation
• Pharyngeal pooling to the level of
• Inadequate bolus preparation
• post swallow oral residue

Question 11

Pharyngeal phase dysphagia

Answer 11

The patient presents with pharyngeal phase dysphagia characterised by delayed pharyngeal swallow resulting in

• Pharyngeal pooling to the level of
• Supra glottic penetration of pre swallow pooling

The patient presents with pharyngeal phase dysphagia characterised by inadequate anterior hyoid movement resulting in
- Decreased epiglottic movement
- Decreased UES opening
- Vellecular residue
- Pyriform sinus residue
- aspiration of supraglottic or pharyngeal residue

The patient presents with pharyngeal phase dysphagia characterised by inadequate base of tongue to posterior pharyngeal wall approximation resulting in
- Post swallow vallecular residue
-Impaired bolus transport through pharynx
- Supraglottic penetration

The patient presents with pharyngeal phase dysphagia characterised by impair UES opening in the presence of substantial anterior hyoid movement resulting in
- Impaired bolus transport through the UES
- Post swallow pyriform sinus residue
-Supraglottic penetration/aspiration of residue

Patient presents with pharyngeal phase dysphagia characterised by poor pharyngeal motility resulting in
- Impaired bolus transport
- Nasal redirection
- Supra glottic penetration
- Diffuse pharyngeal residue
- Supraglottic penetration/aspiration of residue