If you have ever found yourself saying, “my drink went down the wrong pipe”, it typically means it went down your trachea, which may lead to aspiration. Aspiration is the entry of food, liquids or saliva past the vocal folds potentially into the lungs; it is more frequently observed when swallowing fluids. Symptoms typically include coughing, difficulty breathing, and in some cases choking. Normally, everyone encounter’s this process every once in a while due complications coordinating the respiratory and digestive mechanisms. However, individuals with swallowing disorders experience this type of pain and discomfort on a regular basis, which places them at heightened risk for life-threatening complications, such as pneumonia, blood infections, or lung abscess.
Swallowing disorders, also known as dysphagia, may be defined as the difficulty with the transportation of liquids, solids, or both from the pharynx to the stomach. Individuals may encounter difficulty transporting hard textured foods while others have difficulty drinking liquids. Dysphagia, occurs in all age groups and may be a result of a variety of congenital abnormalities, structural damage, or medical conditions. Such conditions typically include, Cerebral Vascular Accidents (CVA), nervous system disorders (i.e., Parkinson’s Disease, Multiple Sclerosis, Cerebral Palsy, respiratory complications, esophageal complications including gastroesophageal reflux (GERD), Traumatic Brain Injury (TBI), head and neck cancer, etc. Other conditions may include intake of antihistamine medication or associated psychological behaviors.
The following are typical signs and symptoms of dysphagia:
- Inability to recognize food
- Coughing before, during, or after the swallow
- Difficulty managing food within the oral cavity
- Sudden weight loss
- Change in vocal quality (gurgly/wet)
- Pain when swallowing (odynophagia)
- Gastroesophageal Reflux (GERD)
The four phases of swallowing that encompass the transportation of food to the stomach.
- Oral Preparatory Phase: the formation of the “bolus” or chewed up food
- Sensory recognition of food or identification that it’s in front of them
- Rotary chew pattern/movement and manipulation of the consistency to form a cohesive ball or “bolus”
- Lateralization the tongue and chewing with the back molars for bolus formation
- Oral Phase: the movement of the “bolus” from the front to back of the mouth
- Tongue pushes the bolus backwards
- Labial closure while chewing to prevent food from lip spillage
- Cheek tension increases to inhibit pocketing of food and increase tension for bolus formation
- Pharyngeal Phase: the transportation of the “bolus” from the top of the pharynx to the bottom of the pharynx
- Vocal fold closure and downward movement of the epiglottis to cover entrance into larynx for airway protection
- Velopharyngeal closure to prevent regurgitation (food to going back up nasal cavity)
- Laryngeal excursion is the upward and forward movement of the larynx and hyoid bone while the upper esophagus is opening to help bolus move down. Additionally, it helps to protect the airway by pulling it out of the way.
- Pharyngeal walls contract (pharyngeal constrictors) to help push the bolus through to the bottom of the pharynx
- Esophageal Phase: encompasses the passage of the “bolus” from bottom of the pharynx to the stomach
- Peristalsis is the action of the esophageal muscles to help push the bolus down the esophagus to the stomach
- Referral to a gastroenterologist is typically the most appropriate for patients experiencing esophageal stage dysphagia
Ashley F, M.S., CF-SLP TSSLD