Oropharyngeal swallowing disorders Flashcards
Differentiate penetration from aspiration
penetration: material enters laryngeal vestibule but does not descend below the vocal folds into the trachea
aspiration: entry of material below the level of the vocal folds into the trachea
List complications of dysphagia
mortality pneumonia malnutrition dehydration decreased rehabilitation potential decreased QoL increased length of hospital stay, cost
What are the two phases of the oral stage of swallowing
the “horizontal subsystem”
preparatory phase and oral transport phase
Describe the preparatory phase of the oral stage of swallowing
Saliva is mixed with material, enzymes break down solid material, the tongue/lips/jaw/ teeth/ facial muscles coordinate to transform the bolus to an appropriate consistency
Describe the oral transport phase of the oral stage of swallowing
Bolus is transported from the front of the cavity to the oropharynx, materials are propelled through lingual force from the anterior oral cavity to the posterior oral cavity
Contrast the roles of the intrinsic and extrinsic tongue muscles in the oral stage of swallowing
Intrinsic Tongue Muscles facilitate containment.
Extrinsic Tongue Muscles facilitate bolus transport.
The ______ stage of swallowing is a sequence of rapid, highly coordinated neuromuscular events causing pressure changes critical to bolus transport
pharyngeal
Describe the events that make up the pharyngeal stage of swallowing
- velopharyngeal closure prevents nasal regurgitation
- backward thrusting of the tongue base to the pharyngeal wall generates pressure on the bolus, driving it from teh valleculae to the esophageal inlet at the cricopharyngeal region
- elevation and forward movement of the hyoid bone and larynx assists with closure of the UES
- movement of the epiglottis downward is a mechanical effect of hyolaryngeal elevation and anterior movement, bolus pressure, and tongue base retraction. the epiglottis covers the laryngeal vestibule, contributing to airway protection
- laryngeal closure progresses from the true vocal folds upward to the false focal folds and laryngeal entrance at teh aryepiglottic folds and epiglottis
- UES relaxation and opening involves upward and forward traction of the hyolaryngeal complex, permits passage of food through the esophagus
- contractile peristaltic wave moves down the pharyngeal wall following the bolus, contributing to the pressure on the bolus
Describe the esophageal stage of swallowing
The bolus is moved from the UES to the LES and into the stomach by gravity and peristalsis.
Two to three seconds following initiation of swallowing, the LES relaxes and remains open until the peristaltic wave passes.
Unlike the UES, in a connected series of swallows, LES opens with the first swallow and remains open until the peristaltic wave passes.
List neurogenic disorders that can result in dysphagia
stroke
Parkinson’s
tumors/ neoplasms
head injury
List non-neurogenic causes of dysphagia
systemic disorders
iatrogenic
obstructive
psychiatric
List symptoms of oropharyngeal dysphagia
drooling residue in mouth difficulty chewing choking lump in throat sensation leaving food on plate/ change in eating habits/ weight loss/ won't accept food
List symptoms of aspiration
coughing with meds or meals increased secretions- "wet gurgly voice" fever abnormal lung sounds on exam reduce oral intake
What is the limitation of non-instrumental evaluation of dysphagia?
Cannot rule out aspiration with adequate level of confidence
Cannot determine where or why there is impedance to bolus flow
What is the preferred diagnostic study for dysphagia?
Videofluoroscopic study with or without manometry
