Phases of swallowing

Question 1

Identify and briefly describe the 4 phases of swallowing

Answer 1

1. Oral preparatory phase- lips contain bolus in mouth, food is manipulated in the mouth and masticated if necessary, reducing it to a consistency ready for swallowing
2. Oral phase- tongue propels food posterior until the pharyngeal swallow is triggered
3. Pharyngeal phase- bolus is moved through the pharynx
4. Esophageal phase- esophageal peristalsis carried the bolus through the cervical and thoracic esophagus down into the stomach

Question 2

The duration and characteristic of each swallow phase is dependent on?

Answer 2

The type and volume of food being swallowed

Question 3

Swallowing and respiration have reciprocal functions…. what does this mean

Answer 3

Respiration halts during the pharyngeal phase of swallowing

Question 4

List the 11 components of swallowing

Answer 4

1. Lip closure
2. tongue control/bolus hold
3. Bolus prep/mastication
4. bolus transport
5. initiation of pharyngeal swallow
6. soft palate elevation
7. hyolaryngeal elevation (Laryngeal elevation + anterior hyoid excursion)
8. laryngeal closure (epiglottis closure +laryngeal vestibular closure + pharyngeal stripping wave + pharyngeal contraction +tongue base retraction)
9. Upper esophageal sphincter opening
10. esophageal clearance
11. lower esophageal relaxation

Question 5

When is the oral phase of swallowing termination?

Answer 5

When the bolus head passes any point between the anterior faucial pillars and where the mandible crossess the tongue base

Question 6

What organs are involved in laryngeal closure

Answer 6

-epiglottis (aryepiglottic folds)
-False vocal folds
-True vocal folds

Question 7

What are the contraction patterns during esophageal clearance

Answer 7

1. primary peristalsis (transit)- swallow initiated
2. Secondary peristalsis- esophageal body
3. Tertiary contractions- simultaneous non-productive

Question 8

What three factors affect esophageal clearance

Answer 8

-number of swallows
-effects of bolus volume
-effects of bolus temperature

Question 9

2 major components contributing to lower esophageal segment sphincteric pressure

Answer 9

-muscle tone
-diaphragm

Question 10

Sensation in what 4 areas if important for swallowing

Answer 10

1. tongue
2. larynx (supraglottic space + subglottic space)
3. pharynx (constrictors, upper esophageal sphincter)
4. esophagus

Question 11

What is the role of sensory feedback in mastication

Answer 11

• Monitor the progress of chewing and modify commands
• Monitor food hardness

Question 12

What monitors the progress of chewing and modifies commands

Answer 12

receptor system in dentures, tongue, cheeks, jaw elevator muscles, temporomandibular joint

Question 13

What is one of the major inputs into central pattern generator (CPG) where motor taste of mastication is controlled

Answer 13

food hardness

Question 14

2 major sensory modulations in swallowing

Answer 14

1. sensory feedback in mastication2. integration of chemical senses

Question 15

What is meant by integration of chemical senses?

Answer 15

Flavor perception gathered through smell and taste

Question 16

Explain the two components of flavor perception

Answer 16

Integration of chemical sense 1. smell & 2. taste

1. smell identifies, detects the concentration, and the quality of the odorant chemical stimuli
2. taste provide information on identity (sweet, sour, salty, etc.), temperature, texture, and location

Question 17

Explain taste reception

Answer 17

taste involves conjunction of olfactory and trigeminal chemoreceptive systems to provide information on identity (sweet, sour, salty, etc.), temperature, texture, and location

Question 18

explain smell reception

Answer 18

smell involves sensory receptors in the olfactory epithelium that detect the identify, concentration, and quality of the odorant chemical stimuli

Question 19

3 types of stimuli seen in sensory modification

Answer 19

1. chemical stimuli
2. thermal stimuli
3. tactile stimuli

Question 20

What are chemical stimuli

Answer 20

saliva stimulation
water
citric acid
sour bolus

Question 21

What is thermal stimuli

Answer 21

Hot vs cold

Question 22

What is tactile stimuli

Answer 22

Touch and pressure:
-Larger bolus
-Viscosity
-air puff stimulation

Question 23

Four main functional aspects of dysphagia

Answer 23

• bolus transit
  -airway protection
  -pump failure
  -sensation

Question 24

What structures make up the anterior and posterior seal of the oral cavity during oral preparatory and oral phase

Answer 24

Anterior seal: lips
Posterior seal: velum/soft palate and back of tongue make contact

Question 25

What is the purpose of the posterior seal of the oral cavity

Answer 25

The tongue and soft palate seal to prevent early spillage into the pharynx

Question 26

What is soft palate elevation & what is the purpose

Answer 26

The soft palate elevates making contact with the posterior pharyngeal wall Purpose: prevent bolus from entering into the nasal cavity

Question 27

Role of the tongue during the oral phase of swallowing

Answer 27

The tongue tip elevates, making contact with the hard palate, while cupping the sides to contain the bolus Then the tongue pushes against the hard palate, creating pressure against the bolus tail, to propel the bolus through the oral cavity towards the pharynx

Question 28

When there is penetration or aspiration, what are 4 important factors we want to evaluate?

Answer 28

1. Anatomical changes: presence, absence, or disturbance in swallowing organs 2. Timing: does penetration/aspiration occur before, during, or after swallow 3. Severity: less than or greater than 10% bolus aspirated & constancy of penetration/aspiration 4. Patient response and efficacy: presence/absence of cough; degree of material clearance

Question 29

Strategies/Compensations used if swallow safety is impaired (penetration or aspiration)

Answer 29

1. head turn 2. supraglottic swallow manueuver 3. super-suprasubglottic swallow manueuver 4. Chin tuck 5. Dry swallow 6. volume and/or viscosity modification

Question 30

List the 3 types of penetration

Answer 30

1. flash 2. trace 3. deep

Question 31

If there is a problem with efficiency, causing residue, what are we evaluating?

Answer 31

1. Residue location (oral cavity, tongue base, posterior pharyngeal wall, vallecula, pyriform sinuses, laryngeal vestibule) 2. Amount/percentage of residue (trace, mild, moderate, significant) 3. Patient response (sensation eliminated or reduced & clearance ability eliminated or reduced)

Question 32

Strategies/Compensations used if swallow efficiency is impaired (residue)

Answer 32

1. dry swallow 2. effortful swallow 3. liquid wash 4. head turn 5. Modify texture, consistency, and/or flavor

Question 33

Approximate duration of a normal swallow?

Answer 33

2 seconds or less

Question 34

The muscles of chewing interact with how many pairs of pharyngeal and laryngeal muscles?

Answer 34

26 pairs

Question 35

What type of variations in bolus are accommodated for in normal swallowing

Answer 35

Variations in bolus size, texture, and temperature

Question 36

In the oral preparatory phase of swallowing what 3 things happen?

Answer 36

1. teeth, lips, tongue, cheeks, mandible, and palate grind and manipulate the food 2. food is mixed with saliva 3. formation of a bolus consistency appropriate for safe swallow

Question 37

Approximately how long is the oral phase, pharyngeal phase, and esophageal phase of swallowing?

Answer 37

Oral phase- 1 second Pharyngeal phase- 1 second Esophageal phase- 3 to 4 seconds

Question 38

In the oral phase, what 6 things happen?

Answer 38

1. lips and cheeks contract 2. tongue presses the food against the hard palate 3. food bolus is moved backwards by the tongue 4. a central groove is formed in the tongue as a passage for the bolus 5. bolus is moved to the anterior and posterior faucial (tonsillar) pillars, initiating the pharynegal phase of swallowing 6. the soft palate moves superior and posterior to close off the nasopharynx

Question 39

In the pharyngeal phase, what 8 things happen?

Answer 39

1. Soft palate elevation 2. Pharyngeal tongue propels the food posteriorly 2. Closure of the larynx to the level of the true and false vocal folds 3. retroversion of the epiglottis over the laryngeal vestibule 4. Closure of the laryngeal vestibule 5. elevation of the larynx under the tongue base 6. contraction of the pharyngeal constrictors 7. relaxation of the cricopharyngeal muscles 8. opening of the cricopharyngeal sphincter by upward and forward motion of the larynx

Question 40

What event happens during the esophageal phase?

Answer 40

Peristaltic contractions of musculature resulting in bolus movement into the stomach