Flashcards in Dysphagia Quiz Deck (53)
Name disorders that can possibly lead to dysphagia
– Acute neurological diseases: Stroke, closed head injury
– Chronic neurological diseases: Amyotrophic lateral sclerosis, Parkinson’s, MS, myasthenia gravis, Alzheimer’s, Huntington’s, Neuropathy (T1DM)
– Muscle disorders: Myositis, myopathies, scleroderma
– GI diseases: GERD, hiatal hernia, achalasia, gastroparesis
– Malignancy: Head and neck cancers, stomatitis, mucositis, esophagitis associated with chemotherapy, and radiation therapy
– Others: Inflammation 2° to infection, post intubation, aspiration, esophageal varices, drug side effects, aging
What does FEES mean?
Fiberoptic endoscopic evaluation of swallowing
What is the dysphagia severity scale level 0?
Normal swallowing mechanism
What is the dysphagia severity scale level 1?
Minimal dysphagia; slight deviance from normal swallow. No change of diet is required
What is the dysphagia severity scale level 2?
Mild dysphagia; oropharyngeal dysphagia present, which can be managed by specific swallow suggestions. May need slight modifications in consistency of diet
What is the dysphagia severity scale level 3?
Mild-moderate dysphagia: potential for aspiration exists but is diminished by specific swallow techniques and a modified diet. Time for eating is significantly increased; thus, supplemental nutrition may be indicated
What is the dysphagia severity scale level 4?
Moderate dysphagia: significant potential for aspiration exists. Trace aspiration of one or more consistencies. Patient may eat certain consistencies by using specific techniques to minimize potential for aspiration and/or to facilitate swallowing. Supervision at mealtimes is required. May require supplemental nutrition orally or via feeding tube.
What is the dysphagia severity scale level 5?
Moderately severe dysphagia: Aspiration of 5-10% on one or + consistencies, with potential for aspiration on all consistencies. Cough reflex is absent and nonprotective. Alternative mode of feeding is required to maintain nutritional needs. NPO if pulmonary status is compromised
What is the dysphagia severity scale level 6?
Severe dysphagia: more than 10% aspiration for all consistencies. NPO.
What proportion of people with neurological disorders develop dysphagia?
What proportion of patients in long term care have dysphagia?
What proportion of people who have a stroke develop dysphagia? Aphagia?
Aphagia: 30% (no swallowing)
What are the 3 parts of the pharynx and where are they located?
1. Nasopharynx - between top an hard palate
2. Oropharynx - between hard palate and epiglottis
3. Hypopharynx (or laryngopharynx) - under epiglottis
Where is the larynx?
Between pharynx and the trachea. Houses vocal folds.
What are the two arches inside the oral cavity and what lies between them?
1. Palatoglossal arch (or anterior faucial pillars)
2. Palatopharyngeal arch (or posterior faucial pillars)
Between: Palatine tonsils
What are named the 2 ducts under the tongue?
Ducts of the submandibular gland
What are named the pieces of tissues that 1. keep tongue down, 2. keeps lips with gingivae?
1. Lingual frenulum
2. inferior/superior labial frenulum
What is called the area between the lips, teeth and cheeks?
Name 2 types of tonsils
Palatine and lingual
What is the line in the middle of the palate?
How many times per day do we swallow?
> 1000 times/d
Swallowing requires the coordination of (x) muscles and (y) cranial nerves
x = 25
y = 5-6
In which part of the brain are the cranial nerves?
Name the 6 cranial nerves involved in swallowing
XI: Spinal accessory
What is the motor function of the trigeminal nerve and in which stage of swallowing is it involved?
Motor function: Mastication
Involved in oral preparatory and transit phases
What is the motor function of the facial nerve and in which stage of swallowing is it involved?
Motor function: All muscles of the facial expressions and corneal reflex
Involved in oral preparatory and transit phase
What is the motor function of the Glossopharyngeal nerve and in which stage of swallowing is it involved?
Motor function: Swallowing, gag reflex
Involved in pharyngeal, esophageal phases
What is the motor function of the vagus nerve and in which stage of swallowing is it involved?
Motor function: GI activity, cough reflex
Involved in pharyngeal and esophageal phases
What is the motor function of the Spinal accesory nerve and in which stage of swallowing is it involved?
Motor function: Innervates muscles that control soft palate; constricts pharynx
Involved in pharyngeal phase