Swallowing

Question 1

What are the phases of swallowing?

Answer 1

Oral
Pharyngeal
Oesophageal

Question 2

Is the oral phase of swallowing voluntary or involuntary?

Answer 2

Voluntary

Question 3

What does the oral phase of swallowing consist of?

Answer 3

Preparatory phase

Transit phase

Question 4

What happens in the preparatory phase of swallowing?

Answer 4

Making bolus

Question 5

What happens in the transit phase of swallowing?

Answer 5

Bolus compressed against palate and pushed into oropharynx by tongue and soft palate

Question 6

Is the pharyngeal phase of swallowing voluntary or involuntary?

Answer 6

Involuntary

Question 7

What are the features of the pharyngeal phase of swallowing?

Answer 7

Tongue positioned against hard palate
Soft palate elevated
Suprahyoid and longitudinal muscles shorten
Epiglottis closes over larynx
Bolus moves through pharynx by sequential contraction of constrictors
Relaxation of UOS

Question 8

Why is the tongue positioned against the hard palate in the pharyngeal phase of swallowing?

Answer 8

So food cannot reenter the motuh

Question 9

What is the position of the tongue against the hard palate in the pharyngeal phase of swallowing co-ordinated by?

Answer 9

CN XII

Question 10

Why is the soft palate elevated in the pharyngeal phase of swallowing?

Answer 10

Opens ET

Seals of nasopharynx

Question 11

What is the raising of the soft palate in the pharyngeal phase of swallowing coordinated by?

Answer 11

Tensor palatine (CN V3) and levator palatine (CN X)

Question 12

What is the shortening of the infrahyoid muscle in the pharyngeal phase of swallowing coordinated by?

Answer 12

CN V3, CN VII, CN XII

Question 13

What is the shortening of the longitudinal muscle in the pharyngeal phase of swallowing coordinated by?

Answer 13

CN IX and X

Question 14

What does the shortening of the suprahyoid and longitudinal muscles in the pharyngeal phase of swallowing cause?

Answer 14

Pharynx to widen and shorten to receive bolus

Larynx to elevate and be sealed off by vocal folds

Question 15

What is the closure of the epiglottis over the larynx in the pharyngeal phase of swallowing due to?

Answer 15

The elevated hyoid

Question 16

Is the oesophageal phase of swallowing voluntary or involuntary?

Answer 16

Involuntary

Question 17

What muscle is involved in the oesophageal stage of swallowing?

Answer 17

Upper striated muscle of oesophagus

Question 18

What is the upper striated muscle of oesophagus innervated by?

Answer 18

CN X

Question 19

What can cause dysphagia?

Answer 19

Stroke
Progressive neurological disease
COPD
Dementia

Question 20

Give 2 progressive neurological diseases that can cause dysphagia?

Answer 20

Parkinsons

MS

Question 21

What % of post stroke deaths are due to pneumonia?

Answer 21

30%

Question 22

What are the signs and symptoms of dysphagia?

Answer 22

Coughing
Choking
Sialorrhea (drooling)
Recurrent pneumonia
Change in voice/speech - wet voice
Nasal regurgitation

Question 23

What happens in a swallow assessment?

Answer 23

First assess level of consciousness and postural control
Give small spoonfuls of water
Full history
Videofluroscopy
Fibre-optic endoscopic evaluation

Question 24

Why is a swallow assessment needed in dysphagia?

Answer 24

Because gag reflex is unreliable in determining risk

Question 25

What are the frequently used interventions in dysphagia?

Answer 25

Modify consistency of food and fluid
Modify feeding strategies
Indirectly modify swallow techniques
Modify physiology of swallow mechanism during swallowing
Modify posture
Improve oral hygiene
Introduce strategies to increase confidence and reduce fear of choking
Educating carers