Overview of Dysphagia (ch1) Flashcards
What is dysphagia? (2)
Difficulty swallowing(chronic); Difficulty moving bolus from the mouth to the stomach
True or False: Dysphagia is age-specific
False. Anyone can have dysphagia.
Dysphagia is a secondary issue. What are the etiologies of Dysphagia?
Infection, structural malformations, surgery (thyroid/RLN/cervical), conditions that weaken/damage muscles/nerves (CVA, PD, TBI)
What are the consequences of Dysphagia? (4)
Dehydration, malnutrition, aspiration pneumonia, decreased quality of life
What is Aspiration Pneumonia?
Pneumonia caused by repeated bouts of aspirations of food or liquid.
True or false: some populations more susceptible to aspiration pneumonia
True. Those who are bed-ridden or have poor posture are more likely to have aspiration pneumonia
What are the types of dysphagia? (4)
Oral: tongue movement, lip closure, pocketing, transport
Pharyngeal: airway closure, residues, motility thru pharynx, UES
Oropharyngeal: a component of both oral and pharyngeal present
Esophageal: motility, LES, fistula, diverticulitis, HCI-reflux; ulcer
What are the stages of dysphagia? (3 according to Dr. C)
Oral Prep/Oral: mastication, bolus formation, and bolus transport from the oral cavity to the pharynx; time varies depending on bolus consistency
Pharyngeal: epiglottis inverts over 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; lasts about 1 second
Esophageal: bolus flows through the esophagus via peristaltic contractions of striated and smooth muscle along the esophageal wall; relaxation of LES allows bolus to flow into the stomach
What are some signs and symptoms of Oral or Pharyngeal dysphagia? (a lot)
- coughing or choking with swallowing (before during or after)
- difficulty initiating swallowing
- food sticking in the throat
- xerostomia/sialorrhea
- drooling or spillage
- unexplained weight loss
- change in dietary habits
- penetration
- aspiration
- recurrent pneumonia
- change in voice (wet, gurgly quality)
- nasal regurgitation
- tearing and/or nose running
- sore throat
What is the difference between Penetration and Aspiration?
Penetration: bolus or part of bolus that passes epiglottis into laryngeal vestibule; normal in geriatric population
Aspiration: bolus or part of bolus passes through VF into trachea; if passes the level of the VF its aspiration, even if reflexive cough triggers
What are some signs and symptoms of Esophageal dysphagia? (7)
- sensation of food sticking in the chest or throat
- chest pain
- oral or pharyngeal regurgitation (even from stomach)
- change in dietary habits
- recurrent pneumonia
- reflux
- aspiration
What is the condition that caused Dr. C to feel pain and vomit at Macaroni Grill in Florida with her family?
Esophageal stricture: a narrowing/tightening of the esophageal walls
What are the signs and symptoms of Silent Aspiration?
NO s/s! No cough reflex! However, it is possible to see tearing or runny nose
Why did the priest Dr. C was treating have a yawn as a sign of his silent aspiration?
The Vagus Nerve controls the cough reflex and gives us signs of aspiration. His was messed up and produced a yawn.
What is the difference between Feeding and Swallowing?
Feeding: placement of food in the mouth before initiation of swallow; aka the Oral Prep Stage that’s in the book (salivation, presentation)
Swallowing: transfer of food.drink from mouth to stomach including the oral, pharyngeal, and esophageal stages
What are the components of a Swallow Screening?
A 10-15 min administration/observation of a small bolus
Bedside clinical assessment includes:
-medical history
-level of alertness
-pt interview
-oral motor exam
-assess swallow with small bolus to look for s/s
What are the signs and symptoms you look for during the bedside swallowing screening?
spillage, oral residue, long transit time, cough, throat clear, gurgly voice, tearing, runny nose, wrong sounds (auscultation)
True or False: The swallow screening is a diagnostic?
False. It is pre-diagnostic. You cannot assess A&P. It will help you decide if you need MBS or FEES next.
What is included in diagnostic procedure? (3)
- ID symptoms to explain abnormalities in A&P causing dysphagia (aka ID etiology)
- examine physiology (timing, tongue base motion, epiglottic dysfunction, laryngeal excursion, UES dysfunction, peristalsis, paralysis, sensitivity)
- examine immediate effects of treatment; stimulability
What are the options for Imaging? For non-imaging?
Imaging: FEES/FEESST, videofluoroscopy (MBS), ultrasound, videoendoscopy, scintigraphy
Non-imaging: EMG, EGG, acoustic (accelerometer or stethoscope), pharyngeal manometry
*non-imaging done primarily for research
True or False: Another name for Videofluoroscopy is a Barium Swallow?
False. A Barium Swallow is something totally different. Other names for Videofluoroscopy include MBS, modified, VFSE, and VFSS
What are some categories of treatment for Dysphagia? (8)
- Diet modification
- Compensatory (positional: posture, chin-tuck, head rotation, multiple swallows)
- Maneuver (supraglottic, super-supraglottic, Mendelson, Effortful)
- Exercise (Shaker, Masako, oral muscle strengthening)
- Stimulation (thermal/tactile stim)
- Experimental (NMES “VitalStim”, Deep Pharyngeal Neuromuscular Stimulation, Myofacial release, Botox)
- Prosthetic (palatal lift or obturator)
- Surgery (CP myotomy, diverticulectomy, dilation)
