Lecture 1 Flashcards
What is Dysphagia?
- Difficulty swallowing
- Difficulty moving bolus from the mouth to the stomach
- A chronic condition (That is not age specific)
What are the etiologies of dysphagia?
Dysphagia is always secondary to something:
Infection
Structural malformation
Surgery (Thyroid, RLN, Cervical)
Conditions that weaken/damage muscles or nerves (CVA, PD, TBI)
What are the consequences of dysphagia?
Dehydration
Malnutrition
Aspiration pneumonia
Quality of life
Types of dysphagia
- Oral (tongue movement, lip closure, pocketing, transport)
- Pharyngeal (airway closure, residues, motility, UES)
- Oropharyngeal (An oral and pharyngeal co-occurring)
- Esophageal (motility, LES, fistula, diverticulum, HCI-reflux; ulcer)
What are the 3 Stages of Dysphagia?
- Oral prep/Oral
- Pharyngeal
- Esophageal
Describe the Oral Stage of dysphagia
- The length of the stage varies with bolus consistency
- Mastication, bolus formation, and bolus transport from the oral cavity to the pharynx
Describe the Pharyngeal stage of dysphagia
- Stage lasts about 1 second
- Epiglottis inverts over the laryngeal vestibule
- 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
- Bolus is propelled through the pharynx toward the esophagus by action of pharyngeal constrictors
Describe the Esophageal stage of dysphagia
- Lasts about 10 seconds
- Bolus flows through the esophagus via peristaltic constrictions of striated and smooth muscle along the esophageal wall
- Relaxation of LES allows bolus to flow into the stomach
Signs and Symptoms of Oral or Pharyngeal Dysphagia
- Coughing or choking with swallowing
- Difficulty initiating swallowing (oral staged planned/pharyngeal stage won’t start)
- Food sticking in the throat
- Sialorrhea/xerostomia (too much saliva/not enough)
- Drooling or spillage
- Unexplained weight loss
- Change in dietary habits
- Penetration (If foods gets into larynx)
- Aspiration (If food gets through VF)
- Recurrent pneumonia
- Change in voice (wet/gurgly voice quality)
- Nasal regurgitation
- Tearing and/or nose running
- Sore throat
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
Silent Aspiration
- No signs or symptoms
- No cough reflex
- Possible signs: tearing, runny nose
Feeding
Feeding is the placement of food in the mouth before initiation of swallow
Oral prep stage (salivation, presentation)
Swallowing
Swallowing is the transfer of food/drink from mouth to stomach
- Oral stage
- Pharyngeal stage
- Esophageal stage
Swallow Screening
10-15 minute administration/observation of a small bolus
Bedside clinical assessment
- Medical history
- Level of alertness
- Patient interview
- Oral motor exam
- Assess swallow with small bolus
Signs & Symptoms
- Spillage, oral residue, long transit time, cough, throat clear, gurgly voice, tearing, runny nose, wrong sound (auscultation)
Can NOT assess A&P
Pre-diagnostic
Diagnostic procedure
Identify symptoms to explain abnormalities in anatomy or physiology causing dysphagia (etiology)
- Examines physiology: timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity
- Examines immediate effects of treatments (Are they stimulable)
Diagnostic Imaging Types
FEES/FEESST, videofluroscopy, ultrasounds, videoendoscopy, scintigraphy
Diagnostic Nonimaging Types
EMG, EGG, acoustic (accelerometer or stethoscope), pharyngeal manometry
Treatments
Diet modification - volume, viscosity, texture, temperature, NPO (NG tube, G tube, PEG, J tube, TPN)
Compensatory - positional (posture, chin tuck, head rotation, multiple swallows)
Maneuver - supraglottic, super-supraglottic, Mendelsohn, Effortful
Exercise - Shaker, Masako, oral muscle strengthening
Stimulation - thermal/tactical stimulation
Experimental - Neuromuscular electrical stimulation, deep pharyngeal neuromuscular stimulation, MFR, botox
Prosthetic - palatal lift or obturator
Surgery - CP myotome, diverticulectomy, dilation
Multidisciplinary team
SLP Physician/neurologist/ENT Nursing Dietician OT PT Radiologist Pharmacist Social worker Psychologist
