swallowing disorders based on stages

Question 1

Oral Prep Disorders

Answer 1

Forming the bolus and placing it
Lip seal
Jaw closure and range of motion
Tongue muscle tone, mobility
Holding the bolus is tongues job

Question 2

Swallowing apraxia

Answer 2

(repetitive rocking motion without posterior movement into pharynx) Problem with the peristaltic wave

Question 3

Stasis

Answer 3

residue

Question 4

oral stage

Answer 4

Buccal or tongue movement that causes residue in the sulcus

Question 5

Premature spillage

Answer 5

food/liquid into pharynx
Seal with soft palate and tongue base

Question 6

Slow oral transit

Answer 6

Swallowing apraxia, spillage of food into sulci, weak lingual motion

Question 7

Delayed pharyngeal swallow

Answer 7

The Hyoid should be moving anteriorly (rapid motion) when bolus head passes ramus of mandible (when bolus reaches the ramus of mandible this is the beginning of pharyngeal swallow)
Ramus is the bottom side of the mandible
Hyoid should begin to move up, but in this case the hyoid stays in the same position

Question 8

PHARYNGEAL STAGE DISORDERS

Answer 8

Nasal Regurgitation
Osteophytes
Pharyngeal Weakness
Vallecular residue
Pharyngeal pouch

Question 9

Nasal Regurgitation

Answer 9

Reduced VP (velopharyngeal) closure
Food is coming from the nose
Soft palate elevates and posterior pharyngeal wall closes nasal cavities, if soft palate can not close it tightly the bolus can go up towards the nasal cavity
Can happen later in swallow if VP mech okay
Refer this case to the ENT doctor

Question 10

Osteophytes

Answer 10

Bony growths from vertebrae
May narrow pharynx and/or redirect bolus flow into airway.
Bump from the vertebrae
Common in older people
Can interrupt the swallowing
2nd vertebrae is largest one

Question 11

Pharyngeal Weakness

Answer 11

Food clings to pharyngeal wall and pyriforms. Can be uni- or bilateral. Visualized best A-P view.
Does patient attempt extra dry swallow? (sensory awareness)
Bolus stays in pharyngeal wall area
Residue on the pharynegal wall
One side weakness or both?
Or train one side for management

Question 12

Vallecular residue

Answer 12

Reduced tongue base movement against posterior pharyngeal wall and/or epiglottic insufficiency

Question 13

Pharyngeal pouch

Answer 13

collection of contrast in depression of the pharyngeal wall.
Can create risk for aspiration of pooled contents
Pouch in the pharynx (pharyngeal wall)
Bolus can press on weak pharyngeal wall (depression of pharyngeal wall)
Which then creates the pouch
Can pool and enter the airway

Question 14

Hyoid laryngeal excursion

Answer 14

hyoid and larynx move up and forward

Question 15

Superior movement of hyoid and larynx

Answer 15

Help close the airway

Question 16

Anterior movement of hypid and larynx

Answer 16

open the UES

Question 17

Reduced Laryngeal Elevation

Answer 17

Can be a timing problem
Whether opening or closing
Sometimes the bolus in the vestibule can be related to laryngeal elevation
Epiglottis can be related as well

Question 18

Penetration

Answer 18

Penetration: material/bolus enters laryngeal vestibule but does not pass below TVFs.
If it enters vestibule it is penetration

Question 19

Aspiration

Answer 19

material passes below TVFs.
Normal response cough
Some patients may not show cough after aspiration
They can not feel bolus in the airway
Can happen without bolus entering the vestibule
Tracheosphagueal fisculla (aspiration can happen between esophagus and trachea)

Question 20

PHARYNGEAL-ASPIRATION SCALE

Answer 20

Score Description of Events
1. Material does not enter airway
Normal swallow
2. Material enters the airway, remains above the vocal folds,
and is ejected from the airway.
2-5 is penetration
3. Material enters the airway, remains above the vocal folds,
and is not ejected from the airway.
4 Material enters the airway, contacts the vocal folds,
and is ejected from the airway.
5. Material enters the airway, contacts the vocal folds,
and is not ejected from the airway.
6. Material enters the airway, passes below the vocal folds,
and is ejected into the larynx or out of the airway.
6-8 is aspiration
7. Material enters the airway, passes below the vocal folds,
and is not ejected from the trachea despite effort.
8. Material enters the airway, passes below the vocal folds,
and no effort is made to eject.
Silent aspiration

Question 21

aspiration scale 2-5

Answer 21

penetration

Question 22

aspiration scale 6-8

Answer 22

aspiration

Question 23

aspiration scale 8

Answer 23

silent aspiration

Question 24

Tracheo-esophageal Fistula

Answer 24

Fistula may develop in common wall of trachea and esophagus allowing backflow from esophagus into trachea

Question 25

Zenker’s Diverticulum

Answer 25

CP disorder creates unnatural pressure build up in UES area when swallowing.
Looks like s pouch that will build up on the wall
Over time, pressure causes tissue in cricopharyngeal area to be herniated
Barium enters weakened area (pouch effect) and then dumps contents back into pharynx. Material can go into airway causing aspiration.

Question 26

Esophageal-Pharyngeal Backflow

Answer 26

Can be indicative of a number of esophageal problems.
Backflow indicates UES is re-opening to allow backflow. Can be aspirated.
GERD - Reflux is a specific type of backflow due to LES failure.
Can co-occur with oropharyngeal disorders