Review: Swallowing Physiology

Question 1

deglutition

Answer 1

swallowing

Question 2

dysphagia

Answer 2

difficulty swallowing/feeding

Question 3

3 types of dysphagia

Answer 3

oral:prep and transport
pharyngeal
esophogeal
oropharyngeal: oral transport + pharyngeal

Question 4

Swallow mechanism: oral phase- oral preparation stage

Answer 4

• lips seal
• cheeks tense
• anterior tongue lowered, sides elevated
• posterioir tongue raised (w/ velum seal)
• VP port open

Question 5

Swallow mechanism: oral phase- oral transport stage

Answer 5

• lips seal
• cheeks tense
• anterioir tongue raised against hard palate
• tongue base drops
• VP remains open initially and closes as bolus propels nackwards

Question 6

Pharyngeal Phase (involuntary reflex/triggered)

Answer 6

• VP port closure
• Base tongue contact PPW
• Hyolarynx moves Up + Forward
• Airway closure at 3 levels
• Pharyngeal contractions
• UES open

Question 7

4 Mechanisms of Airway protection

Answer 7

1. hyoid/laryngeal elevation away from path of bolus
2. Epiglottis retroflexion
3. Closure of the laryngeal vestibule
4. Adduction of the false/true vocal folds

Question 8

Esophageal Phase

Answer 8

• UES region opens to allow bolus to enter esophagus
  UES closure
  Tongue back to rest position
  VP port open
  Epiglottis returns
  Airway open (breathing resumes)

Question 9

swallowing in adults: safe swallow

Answer 9

Safe swallow: Food and liquids are
swallowed without any
entering the airway.
* Mostly applies to movements
in the pharyngeal phase.
* However, some impaired
movements in oral phase can
send the bolus into the airway.

Question 10

Swallowing in adults; efficient swallow

Answer 10

• Food and liquid are cleared
  from the mouth and throat
  (pharynx) without any
  significant residue.
• Remaining residue might later
  fall into the airway.

Question 11

Disruption of Deglutition: Before swallow

Answer 11

• Failure of lingual-palatal seal -> premature spillage

Question 12

Disruption of Deglutition: During swallow

Answer 12

• Incomplete epiglottic tilt
• Poor laryngeal elevation
• Reduce elevation/forward of hyoid bone
• Poor laryngeal closure

Question 13

Disruption of deglutition: After swallowing

Answer 13

• Overflow of laryngeal residues
• Reflux
• Other issues related to esophageal dysphagia

Question 14

Warning Signs of Swallowing Difficulty

Answer 14

Coughing w/ signs of
struggle
* Wet vocal quality
* Wet respiration (wheezing)
* Watering eyes
* Gagging
* Facial grimacing
* Sudden change of color
around the lips and face
* Fever (24-48 hours post
suspected incident)
* Excessive drooling
* Increased residuals
* Pocketing of food in the
mouth
* Refusal of foods/liquids
* Significant weight loss
* Feeling of food stuck in the
throat