Intro to Dysphagia

Question 1

What is dysphagia?

Answer 1

A chronic swallowing problem. It can be in either manipulation of the bolus or difficulty in swallowing itself.

Question 2

True or False: Dysphagia is age-specific.

Answer 2

False: Dysphagia can occur amongst any age, from the newborn to the elderly.

Question 3

True or False: Dysphagia is always secondary to another problem.

Answer 3

True.

Question 4

What are the etiologies of dysphagia?

Answer 4

Infections, structural malformations, surgery, nerve damage, muscle weakness

Question 5

What are the consequences of dysphagia?

Answer 5

Dehydration, malnutrition, aspiration pneumonia, and a decreased quality of life.

Question 6

What are the types of dysphagia?

Answer 6

Oral, oropharyngeal, pharyngeal and esophageal.

Question 7

What might lead to oral dysphagia?

Answer 7

Difficulty in tongue movement, lip closure, pocketing and transport.

Question 8

What might lead to pharyngeal dysphagia?

Answer 8

Incomplete airway closure, residues, motility issues, and UES issues.

Question 9

What is oropharyngeal dysphagia?

Answer 9

When there are deficits in both the oral phase and the pharyngeal phase.

Question 10

What might lead to esophageal dysphagia?

Answer 10

Issues with motility, LES, a fistula, a diverticulum, reflux, or an ulcer

Question 11

What is the most important dysphagia and why? Is it very common?

Answer 11

Pharyngeal dysphagia is the most important because of airway protection; it is very common.

Question 12

What does the oral stage consist of?

Answer 12

Mastication, bolus formation, and bolus transport from the oral cavity to the pharynx; basically everything from the lips to the back of the tongue.

Question 13

What does the pharyngeal stage consist of?

Answer 13

The epiglottis inverts over the laryngeal vestibule, the larynx and the hyoid bone are pulled anteriorly and superiorly to open the pharynx, the cricopharyngeus relaxes allowing the bolus to enter the esophagus. Pharyngeal constrictor muscles propel the bolus into the esophagus.

Question 14

What does the esophageal stage consist of?

Answer 14

The bolus is moved down the esophagus via peristaltic waves and the LES relaxes allowing the bolus to move into the stomach.

Question 15

What are signs or symptoms of oral or pharyngeal dysphagia?

Answer 15

• Coughing or choking while swallowing
• difficulty initiating swallow
• food sticking in the throat
• sialorrhea or xerostomia (excessively salivated or dry mouth)
• drooling or spillage
• unexplained weight loss
• change in dietary habits
• penetration
• aspiration
• recurrent pneumonia
• change in voice (wet, gurgly voice)
• nasal regurgitation

Question 16

What signs does silent aspiration have?

Answer 16

None.

Question 17

Explain the difference in penetration and aspiration.

Answer 17

Penetration is when the residue from the bolus sits at or just above the level of the vocal folds. Aspiration is when residue enters the trachea.

Question 18

What are signs/symptoms of esophageal dysphagia?

Answer 18

• Sensation of food sticking in the chest or throat
• oral or pharyngeal regurgitation
• change in dietary habits
• recurrent pneumonia
• reflux
• aspiration

Question 19

Describe the difference in feeding vs. swallowing.

Answer 19

Feeding is the oral prep stage (placement of food before swallow). Swallowing is the transfer of food/drink to the stomach (the three stages.)