Week 6 Swallowing and Voice Flashcards
What are the 4 phases of swallowing?
1) Oral Preparatory Phase- Occurs in mouth. breaking down food, forming bolus.
2) Oral Phase- Occurs in mouth. Tongue pushes bolus towards the throat. Vellum moves up to make sure it doesn’t go into nasal cavity.
3) Pharyngeal Phase- Occurs in throat. Bolus moves into pharynx. Epiglottis inverts/closes airway. A series of reflexive movements occur to keep food out of airway.
4)Esophageal phase- occurs in esophagus. Bolus is moved down to the stomach.
What can go wrong in the oral phase of swallowing?
Food can go into the nasal cavity. Spillage, pocketing, chewing problems.
What can go wrong in the pharyngeal aspect of swallowing?
Epiglottis can fail to cover airway.material goes into airway causing aspiration.
penetration- material goes partially into airway causing coughing/gagging
Residue- material get caught in pockets of throat.
Is swallowing voluntary, involuntary or both?
Both. Oral prep and oral phase are voluntary. Pharyngeal phase and Esophageal Phase are involuntary.
What is Dysphagia
A swallowing disorder. Difficulty or discomfort swallowing.
Symptoms:
-difficulty swallowing
-coughing
-lack of appetite
-fever
-choking on food/liquid
-food feels stuck in throat
What is aspiration
Anytime a material enters the lungs. Could be food/liquids/vomit/blood/mucus
What is aspiration pneumonia?
A lung infection because of material in the lungs
What can cause dysphagia
-stroke
-brain injury
-tumors
-congenital conditions (Cerebral Palsy)
-neuromuscular diseases (Parkinsons)
-other disorder
-anything that impacts timing or strength of muscles.
What ages can have dysphagia?
Any age can have dysphagia.
Pediatric dysphagia- usually related to sucking and chewing.
Adult dysphagia- Oral problems, pharyngeal problems
Esophageal problems.
What is silent aspiration
Material goes into the airway but the body does not show obvious signs. Ex: coughing, choking May show subtle signs: watering eyes, breathing changes.
What is an SLP’s role in bedside swallow evaluation?
1)doctor will order a swallowing evaluation
2)SLP examines patient
-Case history
-patient/family interview
-Mouth and throat exam
-Oral mechanism exam
-Present them with different food and liquids of different thicknesses and textures and make not of how they can swallow them.
3) Give recommendation to doctor. (what diets and textures are safe for the patient)
4) Doctor make the decision
What are signs of aspiration? Overt and Subtle
Overt signs: Coughing/choking, Throat clearing, wet vocal quality
Subtle signs: Watering eyes, red face, Repeated/delayed swallow, Breathing changes.
What diet textures exist for solids?
7- regular
6- soft and bite-sized
5- Minced and moist
4- Pureed
3- Liquidized
What diet textures exist for liquids?
4) Extremely thick
3) Moderately thick
2) Mildly thick
1) Slightly thick
0) Thin
What are the three goals we keep in mind for a patient?
1) Safe- Safe swallow= 100% sure nothing enters airway.
2) Adequate- Make sure patients needs are being met (not malnourished)
3) Least Restrictive- ensure optimal quality of life.
3 systems involved with producing voice
-Resonance
sound gets shaped by the nasal cavity and oral cavity
-Phonation
larynx and vocal folds vibrate to create sound
-Respiration
Lungs and diaphragm work together to push air up.
What features impacts the way we sound
the shape and size of our vocal tract.
What are vocal features?
-Pitch: How high or low a voice’s frequency is
-Quality: smooth, hoarse, strained, breathy
-Loudness: typical amplitude of one’s voice.
How do we know when a voice disorder is present?
When a person’s pitch, quality or loudness differ significantly from that of a person of a similar age, gender, cultural/racial group.
How do our vocal folds change to alter pitch?
High= tense and long
Low= lax and short
How do our vocal folds change to alter volume?
Loud= faster air
Soft= slower air
Organic vs. functional voice disorders
Organic= medical cause, physical abnormality
Functional=Behavioral cause
2 ways to get functional voice disorders
Misuse of vocal chords
Abuse of vocal chords
=phonotrauma
What are ways we can misuse our voice?
-Inappropriate pitch, quality or loudness.
What are ways we can abuse our voice?
Excessive talking, screaming, singing, yelling, coughing, throat clearing, smoking, inhaling irritants.
What can happen as a result of misuse or abuse?
Nodules- calluses on vocal folds.
Laryngitis- inflammation in and around vocal folds.
Polyps- blisters on vocal folds
What can we advise patients to do for functional voice disorders?
-Change behavior that is causing the abuse
-Change environment (job)
-Vocal rest
-Vocal hygiene regiments (Hydrate, warm up voice, lubricate vocal folds)
What does the hard palate separate?
The mouth and the nasal cavity
What is a bolus?
A cohesive mass of food
