Swallowing

Question 1

How many stages of swallowing are there?

Answer 1

4

Question 2

Can you name the swallowing stages?

Answer 2

Oral Preparatory
Oral
Pharyngeal
Oesophageal

Question 3

In the oral preparatory phase, what is the role of CN 5?

Answer 3

Lateral and rotatory chewing?

Question 4

In the oral preparatory phase, what is the role of CN 12?

Answer 4

Motor innervation to the tongue to manipulate food to form a bolus

Question 5

In the oral preparatory phase which muscles contract to decrease bolus entering lateral sulci?

Answer 5

Buccinators

Question 6

In the oral preparatory phase, what is the role of CN 10?

Answer 6

Lowering of soft palate to prevent posterior leakage?

Question 7

Which muscle, and therefore CN is responsible for preventing posterior leakage?

Answer 7

Vagus
Soft Palate (all muscles minus the TVP)

Question 8

When is the oral stage initiated?

Answer 8

When tongue begins posterior bolus movement

Question 9

What is the function of the negative pressure created by the buccinators in the oral phase?

Answer 9

Helps to move the bolus posteriorly

Question 10

How long should the oral stage be?

Answer 10

No more than 1 second

Question 11

When is a swallow triggered?

Answer 11

When the bolus reaches faucial arches - oral stage

Question 12

When does the soft palate elevate?

Answer 12

In the oral stage, as the swallow is initiated.

Question 13

Name the faucial arches?

Answer 13

Palatoglossal and palatopharyngeal arches.

Question 14

Which pair of tonsils sit between the palatoglossal and palatopharyngeal arches?

Answer 14

Palatine

Question 15

Which faucial arch is more posterior?

Answer 15

Palatopharyngeal

Question 16

What is another term for the faucial arches?

Answer 16

The anterior and posterior arches of the palate

Question 17

Is the oral stage voluntary?

Answer 17

Yes, up until point of swallow as it can be involuntary too.

Question 18

The propulsion of the bolus through the pharynx usually takes what length of time?

Answer 18

Less than 1 second

Question 19

What is the Pharyngeal stage?

Answer 19

The propulsion of the bolus through the pharynx

Question 20

During the Pharyngeal stage, the palate elevates. What do the tongue and pharynx do?

Answer 20

Tongue base retracts
Pharynx constricts

Question 21

What are the 3 levels of closure during the pharyngeal stage?

Answer 21

Epiglottis folding over the larynx
Vocal folds adduct
False vocal folds adduct

Question 22

What are the 3 valves of the swallow?

Answer 22

Velopharyngeal
Laryngeal (closures of the pharyngeal stage)
Cricopharyngeal

Question 23

What causes the Cricopharyngeal valve to open?

Answer 23

-Relaxation of the cricopharyngeal muscle
-Larynx moving upward and forward
-Bolus pressure on sphincter

Question 24

What is the function of the valving system during the swallow?

Answer 24

Allows for different areas of pressure.
Positive around the bolus, negative below it.
Allows the bolus to move.

Question 25

Which two structures have to move in order to create the negative pressure which sucks the bolus into the pharynx? In which way do these structures move?

Answer 25

The pharynx + hyoid tilt and elevate

Question 26

What is the normal breathing pattern during swallowing and what is the breathing pattern of the elderly? Why does elderly swallow have an increased aspiration risk?

Answer 26

Normal = breathe in, breathe out slightly, stop swallow, then continue breathing out Elderly = breathe out, breathe in slightly, stop swallow, then continue in Elderly - breathing in after swallow means residue could be aspirated

Question 27

How does the larynx change with age?

Answer 27

Drops up to half and inch - impacts laryngeal valve of epiglottic closure

Question 28

Penetration vs Aspiration

Answer 28

*Penetration occurs when the bolus enters the laryngeal vestibule but is not aspirated below the level of the vocal folds

Question 29

Along with intact sensation, what needs to be effective in order for a person to have an effective cough?

Answer 29

Effective glottic closure | To allow sublottic pressure to build

Question 30

Which CN allows glottic closure? Which muscle does this control?

Answer 30

Vagus Recurrent Laryngeal Nerve Interarytenoids - help to pull epiglottis downwards

Question 31

There are 6 structural changes in the elderly swallow. How many can you name?

Answer 31

1) Increase in fatty and connective tissue in tongue and larynx 2) Reduced mastication strength 3) Reduced secretions bathing vocal folds and pharynx 3) Drop in larynx position 4) Increased likelihood of absent gag reflex 5) Longer transit time

Question 32

Lower oesophageal sphincter not as effective in the elderly, therefore increased risk of ___ important to note if the patient is NG/PEG fed.

Answer 32

Reflux