Pharyngeal and Esophageal Phase Disorders Flashcards
(33 cards)
pharyngeal phase
- the bolus moves from the posterior portion of the tongue through the pharynx to the opening of the esophagus.
- soft palate elevates to close off the nasopharynx
- larynx elevates and moves anteriorly as the epiglottis covers the opening into the trachea.
- the UES (upper esophageal sphincter) relaxes and opens to allow bolus into the esophagus.
oropharyngeal dysphagia
- difficulty moving food to the back of the mouth and starting the swallowing process
- can result from various nerve or brain disorders such as stroke, cerebral palsy, multiple sclerosis, Parkinson’s and Alzheimer’s diseases, cancer of the neck or throat, a blow to the brain or neck, or even dental disorders.
issues related to pharyngeal phase
• Swallowing incoordination • Swallow reflex is absent or delayed • Immature suck/swallow reflex • Structural or physiological factors o Laryngomalacia o Laryngeal cleft o Vocal Cord paralysis o Tracheostomy
swallowing incoordination
- unable to coordinate sucking, swallowing, and breathing
- may suck with good seal and excursion of liquid from the bottle but be unable to handle the bolus of food at the same speed and timing
- interruption of breathing may occur (Apnea)
treatment techniques for swallowing incoordination
- External pacing while eating – the feeder assists the infant in appropriately interspersing breaths during sucking bursts
- Changing the nipple to a slower flow rate
swallow reflex is absent or delayed - which CN
- Damage to CN X (vagus) can result in paralysis of the laryngeal muscles reducing protection of the airway during the swallow
- genetic defect
Prader Willi Syndrome
- genetic syndrome
- absent sucking and gag reflex at birth with generalized low tone to extreme hunger, overeating, and an obsession with food after infancy
immature suck/swallow
– Premature infants will have immature respiratory patterns
- irregular periods of respiration, brief apnea
- With maturity, nutritive and non-nutritive suck/swallow becomes more rhythmic and stable (34 - 40 weeks)
Laryngomalacia
- collapse of the supraglottic laryngeal structures
- symptoms on inspiration since these floppy structures may be pulled into the airway during inspiration.
- Treatment: conservative, changing feeding postures and feeding the infant slowly. Laryngoplasty can also relieve symptoms in select cases.
stridor
- sound produced by turbulent flow of air through a narrowed segment of the respiratory tract
- a sign of airway obstruction in a child
- typically originates from the larynx or trachea
- Infections or abnormalities of the larynx can produce symptoms and signs of airflow obstruction, altered phonation, and/or feeding difficulty.
Laryngeal cleft
- rare congenital anomaly characterized by a midline defect of variable length between the posterior larynx and trachea and the anterior wall of the esophagus
- Embryology: occur at 35 weeks gestation secondary to an agenesis of the tracheoesophageal septum and failure of fusion of the posterior cricoid cartilage.
Presenting symptoms include inspiratory stridor, cyanosis, massive aspiration, recurrent respiratory infections, aspiration or pneumonia.
vocal cord paralysis
- may be caused by head trauma, a neurologic insult such as a stroke, a neck injury, lung or thyroid cancer, a tumor pressing on a nerve, or a viral infection.
- may experience abnormal voice changes and discomfort
recurrent laryngeal nerve (RLN)
carries signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing vocal folds for vocal fold vibration during voice use, and closing vocal folds during swallowing.
**involved in majority of cases of vocal fold paresis or paralysis
Tracheotomy and Tracheosotomy
tracheotomy: incision into the trachea (windpipe) that tracheostomy: hole that is formed (stoma)
- incision is usually vertical in children and runs from the second to the fourth tracheal ring
Decannulation
The removal of a cannula: in the case of children with trachs, the removal of the tracheostomy tube. Decannulation depends on the reason for the trach tube and the course of treatment for the diagnosis or condition for which the trach tube was placed. Once the reason for the tube is resolved, decannulation can be attempted (usually is a hospital setting under the care of an otolarnygologist).
relationship between trach tube and feeding
- endurance can still be limited
- impairment in swallowing
- desensitization of the larynx and loss of protective reflexes
Passy-Muir speaking Valve
- allows a child with a tracheostomy tube to speak more normally
- one-way valve attaches to the outside opening of the tracheostomy tube and allows air to pass into the tracheostomy, but not out through it
- The valve opens when the child breathes in. When the child breathes out, the valve closes and air flows around the tracheostomy tube, up through the vocal cords allowing sounds to be made. The child breathes out through the mouth and nose instead of the tracheostomy.
cuffed trachs
- tracheostomy tubes that are blocked and sealed
- the cuff blocks any air from flowing around the tube and assures that the patient is well oxygenated. All the air must therefore flow in and out through the tube itself.
cuffless trachs
- primarily used in non-ventilated patients who have no difficulty swallowing and have no danger of aspiration - also used frequently with children due to small anatomical structures
- allows air to pass into the upper trachea and larynx so the patient can cough and speak normally
special considerations with pharyngeal disorders
- maintain in upright position
- take small bites and eat slowly
- avoid talking while eating
- place food in stronger side of the mouth
- chin tuck during swallow
National Dysphagia Diet
- Level I: Puree consistency diet (homogenous, very cohesive, pudding-like, requiring very little chewing ability).
- Level 2: Mechanical Altered (cohesive, moist, semisolid foods, requiring some chewing).
- Level 3: Dysphagia-Advanced (soft foods that require more chewing ability).
- Regular (all foods allowed).
esophageal phase
begins with the opening of the upper esophageal sphincter. The bolus moves through the muscular esophagus by peristalsis. The swallow itself and the sensation of the bolus triggers peristalsis to begin.
problems with esophageal phase disorders
• Reflux
• Structural and Physiological
o Tracheoesophageal fistula
o Diaphragmatic hernia
Gastroespohageal Reflux (GER)
LES relaxes and allows the stomach contents to reflux back into the esophagus
