Typical and Atypical Swallowing

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Questions and Answers

During this phase, rotary and lateral tongue movements control placement of the bolus on the teeth and within the oral cavity

Oral (correct)

Pharyngeal

Esophageal

None of the above

The ______ phase is a series of steps occurring in well-organized, efficient, rapid manner to allow for safe, effective swallowing. This involuntary stage takes less than 1 sec.

None of the above

Oral

Pharyngeal (correct)

Esophageal

Pain swallowing is known as _____. This can be caused by environmental, behavioral, and medical conditions. Provide 3 examples of what can cause painful swallowing.

Presbyphagia

Odynophagia (correct)

Sarcopenia

Aspiration

Decreased epiglottic closure or inversion and decreased laryngeal closure can result in penetration and/or aspiration ______ the swallow.

During Signup and view all the answers

Name 5 signs/symptoms of oropharyngeal dysfunction

Prolonged feeding Oral expectoration/anterior spill Nasal regurgitation Uncontrolled bolus flow into pharynx Laryngeal vestibule penetration Aspiration and recurrent PNA (pneumonia) Stasis Residue Signup and view all the answers

Match the cranial nerve to its function

Lip closure; Rotary and lateral jaw movements = CN V, VII Rotary and lateral tongue movements = CN XII Bulging of SP = CN X Facial tone = CN VII Signup and view all the answers

The oral stage ends and the pharyngeal stage is triggered at this point.

When the head of bolus (more than ⅔ of bolus) reaches the cross point between the jaw and base of tongue Signup and view all the answers

During the _______ phase, the palatopharyngeus and the levator veli palatini contract to raise SP and block nasal cavity, simultaneous inhibition of respiration (caused by reduced innervation of diaphragm and phrenic nerve).

Pharyngeal Signup and view all the answers

The UES allows food entry into the stomach but is otherwise closed to prevent reflux/retrograde movement?

False Signup and view all the answers

The ____ _ stage is voluntary and takes less than one second. The primary driving force of this stage is the ____.

Bolus propulsion/oral transit; tongue Signup and view all the answers

Anterior movement of the larynx provides extrinsic stretching of CP/UES region. It occurs because of the anterior movement of the hyoid bone due to the contraction of the and _ muscles.

Geniohyoid, mylohyoid Signup and view all the answers

Airway protection is a bottom up process. Closure begins at the true VFS, then the ___, then the _ folds, then the ______.

False VFS - Aryepiglottic folds - Epiglottis Signup and view all the answers

The pharyngeal swallow is triggered by receptors that carry input to the swallowing center in the reticular formation of the brainstem via CN’s IX, X as the bolus passes the faucial arches.

True Signup and view all the answers

The upper esophageal sphincter (UES) is comprised of these 3 structures

Cricopharyngeus muscle Fibers of inferior pharyngeal constrictor Cricoid cartilage to which muscles attach Signup and view all the answers

Epiglottic movement occurs due to these 3 forces:

Bolus pressure Downward pull of muscular forces (primarily aryepiglottic muscles) Combined pressure of tongue base moving posteriorly and larynx elevating and moving anteriorly which folds epiglottis down and over laryngeal inlet Signup and view all the answers

Lip seal is required during this phase as the tongue moves up and back and contracts the palate in a sequential rolling action. The bolus movies posteriorly to the back of the tongue.

Bolus propulsion/oral transit Signup and view all the answers

Relaxation of the cricopharyngeus (CP) muscle occurs (CN X innervation) to allow entry of the bolus into the esophagus and is responsible for a large portion of its opening.

False Signup and view all the answers

What is the difference between penetration and aspiration?

Penetration: When any foreign substance sits at the level of the TVF Aspiration: When any foreign substance goes below the TVF Signup and view all the answers

Decreased soft palate anterior bulge causes decreased pressure in the bolus moving through the pharynx.

True Signup and view all the answers

Decreased cricopharyngeus (CP) opening can result in pooling of residue in the py pyriform sinuses and may spill into the airway ______ the swallow (before, during, or after).

After Signup and view all the answers

_______ is the age related changes in swallowing as demonstrated by healthy older individuals.

Presbyphagia Signup and view all the answers

_______ is muscular atrophy associated with age.

Sarcopenia Signup and view all the answers

Reduced oral control of bolus can result in aspiration _____ the swallow. (before, during, or after)

Before Signup and view all the answers

Post-swallow wet/gurgly vocal quality can be a predictor/risk for aspiration. What causes the perception of wet/gurgly vocal quality?

When the bolus or residue is left in the laryngeal vestibule (on the underside of the epiglottis or on the VFS) the air vibrates the material in its path Signup and view all the answers

Provide 3 examples of what occurs with aging:

Reduces smell and taste Dentures Ossification of laryngeal cartilage leading to reduced mobility Aged related illness and medical conditions Reduced appetite Increased residue in pyriform sinuses Penetration into laryngeal vestibule clearing is normal Increased incidence of aspiration on repeat swallow trails - attributed to fatigue Reduced function reserve Signup and view all the answers

Provide 3 examples of etiologies of esophageal dysfunction.

CP dysfunction Esophageal dysmotility Reflux Esophageal bar Zenker’s diverticulum Underdeveloped GI systems (infants) Growth/tumor Tertiary contraction Signup and view all the answers

Decreased pharyngeal contraction (unilateral) causes food/liquid to collect on the _____ side (damaged or undamaged).

Damaged Signup and view all the answers

Decreased vertical/anterior/posterior range of tongue movement (aka tongue coordination) and the perception that more work is involved. As a result, the bolus may be post prematurely. Since the airway is open due to the absence of a swallow trigger, aspiration may occur _____ the swallow.

During Signup and view all the answers

Decreased pharyngeal contraction (bilateral) can result in pooling of residue on both sides in the valleculae, pyriform and on the pharyngeal wall. This residue can then spill into the laryngeal vestibule resulting in penetration and/or aspiration ______ the swallow.

After Signup and view all the answers

What is the primary function of the rotary and lateral tongue movements during the oral stage?

To control the placement of the bolus on the teeth and within the oral cavity Signup and view all the answers

Which cranial nerve is responsible for the bulging of the soft palate during the oral stage?

CN X Signup and view all the answers

What is the result of the anterior bulging of the soft palate during the oral stage?

Narrowing of the passageway into the oropharynx Signup and view all the answers

How many salivary glands are involved in mixing food with saliva during the oral stage?

3 Signup and view all the answers

What is the purpose of the rotary and lateral jaw movements during the oral stage?

To facilitate chewing and mixing of food with saliva Signup and view all the answers

What marks the end of the oral stage and the beginning of the pharyngeal stage?

When the tongue brings all pieces of food together to form a bolus Signup and view all the answers

What is the primary function of the Upper Esophageal Sphincter (UES)?

To prevent reflux/retrograde movement Signup and view all the answers

What is the result of decreased oral control of the bolus?

Premature loss of the bolus into the pharynx Signup and view all the answers

What is the name of the age-related muscle atrophy that affects swallowing?

Sarcopenia Signup and view all the answers

What is the sequence of closure during airway protection?

True vocal folds, then false vocal folds, then aryepiglottic folds Signup and view all the answers

What is the result of decreased epiglottic closure?

Penetration and/or aspiration into the airway Signup and view all the answers

What is the primary driving force of the oral stage of swallowing?

Tongue movement Signup and view all the answers

What is the name of the swallowing impairment that occurs in healthy older individuals?

Presbyphagia Signup and view all the answers

What is the result of decreased pharyngeal contraction?

Pooling of residue in the valleculae and pyriform sinuses Signup and view all the answers

What is the primary function of the cricopharyngeus muscle?

To relax and allow entry of the bolus into the esophagus Signup and view all the answers

What is the result of decreased soft palate anterior bulge?

Decreased pressure in moving the bolus through the pharynx Signup and view all the answers

What is the primary cause of nasal regurgitation?

Reduced or incomplete soft palate elevation Signup and view all the answers

What is the primary driving force of the voluntary stage of swallowing?

Tongue Signup and view all the answers

What can cause a delay in the trigger of the pharyngeal swallow?

Change in tongue range or pattern of movement Signup and view all the answers

What can result from decreased pharyngeal contraction (unilateral)?

Food liquid collects on the damaged side Signup and view all the answers

What is the result of inadequate lip seal during the oral stage of swallowing?

All of the above Signup and view all the answers

What is the focus of treatment for epiglottic inversion?

Force of the tongue base, bolus itself, and swallow trigger Signup and view all the answers

What is the position of the bolus head when the pharyngeal swallow is initiated?

At the posterior angle of the ramus Signup and view all the answers

What is a predictor/risk for aspiration?

Post-swallow wet/gurgly vocal quality Signup and view all the answers

What is the result of simultaneous inhibition of respiration during the pharyngeal stage of swallowing?

Reduced innervation of the diaphragm and phrenic nerve Signup and view all the answers

What is the purpose of the anterior movement of the larynx during the pharyngeal stage of swallowing?

To provide extrinsic stretch of the CP/UES region Signup and view all the answers

What can cause uncontrolled bolus flow into the pharynx?

All of the above Signup and view all the answers

What is the result of decreased pharyngeal contraction during the pharyngeal stage of swallowing?

Pooling of residue in the valleculae Signup and view all the answers

What is the result of decreased laryngeal elevation?

Increased food in the inlet inhaled after the swallow Signup and view all the answers

What can cause residue to remain in the pharynx and work its way down into the airway?

Decreased pharyngeal contraction Signup and view all the answers

What is the purpose of the contraction of the palatopharyngeus and levator veli palatini muscles during the pharyngeal stage of swallowing?

To raise the soft palate and block the nasal cavity Signup and view all the answers

What is the result of decreased UES opening during the pharyngeal stage of swallowing?

Pooling of residue in the pyriform sinuses Signup and view all the answers

What is the primary goal of therapy for swallowing disorders?

Protection of the airway Signup and view all the answers

What can cause laryngeal vestibule penetration?

Decreased epiglottic closure Signup and view all the answers

What is the age-related change in swallowing that occurs in healthy older individuals?

Presbyphagia Signup and view all the answers

What is the term for painful swallowing?

Odynophagia Signup and view all the answers

What is the primary concern when aspiration occurs during the swallow?

Aspiration can lead to recurrent PNA Signup and view all the answers

What is the result of decreased cricopharyngeal muscle opening?

Pooling of residue in the valleculae Signup and view all the answers

What is the cause of odynophagia?

Ulcers, abscesses, or upper respiratory tract infections Signup and view all the answers

What is the characteristic of a patient with esophageal dysfunction?

Retrograde bolus flow Signup and view all the answers

What is the significance of a throat clear or cough during the swallow?

It is a sign of a partially intact and responsive system Signup and view all the answers

What is the result of decreased pharyngeal contraction?

Pooling of residue in the valleculae Signup and view all the answers

What is the cause of penetration during the swallow?

Decreased epiglottic closure or inversion Signup and view all the answers

What is the characteristic of a patient with oropharyngeal dysfunction?

Liquid favored over solids Signup and view all the answers

What is the result of inadequate pharyngeal contraction or hypertonicity?

Spillage of residue into the airway Signup and view all the answers

What is the age-related change in swallowing?

Presbyphagia Signup and view all the answers

Study Notes

Swallowing Stages and Coordination

Typical swallowing involves oral prep, pharyngeal, and esophageal stages, each requiring precise coordination of muscle movements.
Oral prep stage includes lip closure, rotary jaw movements, and tongue manipulation to form a cohesive bolus from food mixed with saliva.
The critical moment of oral stage ends when the tongue positions the bolus for swallowing, with variations in bolus size and temperature affecting timing.
Cranial nerves (CN V, VII, XII, X) play key roles in motor coordination for each swallowing component.

Pharyngeal Stage

Characterized by swift involuntary responses, the pharyngeal phase of swallowing takes less than one second.
Bolus sensation triggers a swallow response via CN IX and X, leading to laryngeal elevation and airway protection.
Closure of all sphincters occurs, including the epiglottis, preventing materials from entering the airway.
Epiglottic movement, affected by muscular actions and bolus pressure, ensures safe passage of food into the esophagus while safeguarding the airway.

Esophageal Stage

Longest phase lasting between 8-20 seconds, involving involuntary peristalsis and the lower esophageal sphincter (LES) permitting food entry into the stomach.
The pathway includes coordinated relaxation of the cricopharyngeus muscle and tension maintenance to keep the UES closed at rest.

Airway Safety and Coordination

During swallowing, respiration is temporarily suspended to protect the airway; multi-tiered closure mechanisms start at the true vocal folds and progress to the epiglottis.
Disturbances in swallowing may lead to penetration (foreign substance at vocal folds) or aspiration (substance below vocal folds).

Impact of Aging on Swallowing (Presbyphagia)

Approximately 15% of individuals over 60 exhibit dysphagia, with aging inducing physiological changes that may slow oral transit and swallowing.
Sarcopenia causes muscle atrophy, contributing to decreased efficiency and increased risk of aspiration during swallowing.

Signs and Symptoms of Swallowing Disorders

Symptoms include prolonged feeding, oral spill, nasal regurgitation, and aspiration leading to pneumonia.
Indications of dysfunction can manifest through residue of food in the mouth, gurgly vocal quality, and avoidance of certain textures.

Impairments and Considerations in Swallowing

Common impairments during bolus preparation involve decreased lip closure and facial tone, affecting intraoral pressure and subsequently bolus control.
Delayed trigger mechanisms can cause aspiration before swallowing as bolus enters the pharynx.
Pharyngeal phase disruptions may occur from insufficient soft palate elevation and decreased laryngeal closure, increasing risk for aspiration.

Esophageal Considerations

Dysfunction in the cricopharyngeal area may lead to pooling and backflow, as well as esophageal dysmotility causing retrograde flow and reflux issues.
Odynophagia (painful swallowing) may arise from various medical conditions, reflecting underlying infections or structural issues.

Behavioral Patterns Affecting Swallowing

Patients may develop avoidance patterns, preferring liquids over solids based on neuromuscular or structural challenges impacting swallowing efficacy.
Clinical interventions may focus on optimizing airway protection through targeted strengthening and coordination exercises for affected muscle groups.

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Typical and Atypical Swallowing

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Podcast

Questions and Answers

During this phase, rotary and lateral tongue movements control placement of the bolus on the teeth and within the oral cavity

The ______ phase is a series of steps occurring in well-organized, efficient, rapid manner to allow for safe, effective swallowing. This involuntary stage takes less than 1 sec.

Pain swallowing is known as _____. This can be caused by environmental, behavioral, and medical conditions. Provide 3 examples of what can cause painful swallowing.

Decreased epiglottic closure or inversion and decreased laryngeal closure can result in penetration and/or aspiration ______ the swallow.

Name 5 signs/symptoms of oropharyngeal dysfunction

Match the cranial nerve to its function

The oral stage ends and the pharyngeal stage is triggered at this point.

During the _______ phase, the palatopharyngeus and the levator veli palatini contract to raise SP and block nasal cavity, simultaneous inhibition of respiration (caused by reduced innervation of diaphragm and phrenic nerve).

The UES allows food entry into the stomach but is otherwise closed to prevent reflux/retrograde movement?

The ________ _______ stage is voluntary and takes less than one second. The primary driving force of this stage is the ______.

Anterior movement of the larynx provides extrinsic stretching of CP/UES region. It occurs because of the anterior movement of the hyoid bone due to the contraction of the ____ and _____ muscles.

Airway protection is a bottom up process. Closure begins at the true VFS, then the _____, then the _____ folds, then the ________.

The pharyngeal swallow is triggered by receptors that carry input to the swallowing center in the reticular formation of the brainstem via CN’s IX, X as the bolus passes the faucial arches.

The upper esophageal sphincter (UES) is comprised of these 3 structures

Epiglottic movement occurs due to these 3 forces:

Lip seal is required during this phase as the tongue moves up and back and contracts the palate in a sequential rolling action. The bolus movies posteriorly to the back of the tongue.

Relaxation of the cricopharyngeus (CP) muscle occurs (CN X innervation) to allow entry of the bolus into the esophagus and is responsible for a large portion of its opening.

What is the difference between penetration and aspiration?

Decreased soft palate anterior bulge causes decreased pressure in the bolus moving through the pharynx.

Decreased cricopharyngeus (CP) opening can result in pooling of residue in the py pyriform sinuses and may spill into the airway ______ the swallow (before, during, or after).

_______ is the age related changes in swallowing as demonstrated by healthy older individuals.

_______ is muscular atrophy associated with age.

Reduced oral control of bolus can result in aspiration _____ the swallow. (before, during, or after)

Post-swallow wet/gurgly vocal quality can be a predictor/risk for aspiration. What causes the perception of wet/gurgly vocal quality?

Provide 3 examples of what occurs with aging:

Provide 3 examples of etiologies of esophageal dysfunction.

Decreased pharyngeal contraction (unilateral) causes food/liquid to collect on the _____ side (damaged or undamaged).

Decreased vertical/anterior/posterior range of tongue movement (aka tongue coordination) and the perception that more work is involved. As a result, the bolus may be post prematurely. Since the airway is open due to the absence of a swallow trigger, aspiration may occur _____ the swallow.

Decreased pharyngeal contraction (bilateral) can result in pooling of residue on both sides in the valleculae, pyriform and on the pharyngeal wall. This residue can then spill into the laryngeal vestibule resulting in penetration and/or aspiration ______ the swallow.

What is the primary function of the rotary and lateral tongue movements during the oral stage?

Which cranial nerve is responsible for the bulging of the soft palate during the oral stage?

What is the result of the anterior bulging of the soft palate during the oral stage?

How many salivary glands are involved in mixing food with saliva during the oral stage?

What is the purpose of the rotary and lateral jaw movements during the oral stage?

What marks the end of the oral stage and the beginning of the pharyngeal stage?

What is the primary function of the Upper Esophageal Sphincter (UES)?

What is the result of decreased oral control of the bolus?

What is the name of the age-related muscle atrophy that affects swallowing?

What is the sequence of closure during airway protection?

What is the result of decreased epiglottic closure?

What is the primary driving force of the oral stage of swallowing?

What is the name of the swallowing impairment that occurs in healthy older individuals?

What is the result of decreased pharyngeal contraction?

What is the primary function of the cricopharyngeus muscle?

What is the result of decreased soft palate anterior bulge?

What is the primary cause of nasal regurgitation?

What is the primary driving force of the voluntary stage of swallowing?

What can cause a delay in the trigger of the pharyngeal swallow?

What can result from decreased pharyngeal contraction (unilateral)?

What is the result of inadequate lip seal during the oral stage of swallowing?

What is the focus of treatment for epiglottic inversion?

What is the position of the bolus head when the pharyngeal swallow is initiated?

What is a predictor/risk for aspiration?

What is the result of simultaneous inhibition of respiration during the pharyngeal stage of swallowing?

What is the purpose of the anterior movement of the larynx during the pharyngeal stage of swallowing?

What can cause uncontrolled bolus flow into the pharynx?

What is the result of decreased pharyngeal contraction during the pharyngeal stage of swallowing?

What is the result of decreased laryngeal elevation?

What can cause residue to remain in the pharynx and work its way down into the airway?

What is the purpose of the contraction of the palatopharyngeus and levator veli palatini muscles during the pharyngeal stage of swallowing?

What is the result of decreased UES opening during the pharyngeal stage of swallowing?

What is the primary goal of therapy for swallowing disorders?

What can cause laryngeal vestibule penetration?

What is the age-related change in swallowing that occurs in healthy older individuals?

What is the term for painful swallowing?

What is the primary concern when aspiration occurs during the swallow?

What is the result of decreased cricopharyngeal muscle opening?

What is the cause of odynophagia?

What is the characteristic of a patient with esophageal dysfunction?

What is the significance of a throat clear or cough during the swallow?

What is the result of decreased pharyngeal contraction?

What is the cause of penetration during the swallow?

What is the characteristic of a patient with oropharyngeal dysfunction?

What is the result of inadequate pharyngeal contraction or hypertonicity?

What is the age-related change in swallowing?

Study Notes

The ____ _ stage is voluntary and takes less than one second. The primary driving force of this stage is the ____.

Anterior movement of the larynx provides extrinsic stretching of CP/UES region. It occurs because of the anterior movement of the hyoid bone due to the contraction of the and _ muscles.

Airway protection is a bottom up process. Closure begins at the true VFS, then the ___, then the _ folds, then the ______.