CSD 5200

Oral Stage General Disorders

Pharyngeal Stage General Disorders

Neruomuscular and Anatomic Disorders of Swallowing

Decreased labial stength
  • Patient Description
    • Unable to keep food in mouth
  • Clinical Symptom
    • Food falling from the mouth.
  • Radiographic Symptom
    • Food falling from the mouth

Inability to lateralize material with tongue.

  • Patient Description
    • Cannot chew
    • Avoid foods requiring mastication
  • Clinical Symptom
    • Material remains midline on tongue or falls into sulcus.
  • Radiographic Symptom
    • Material remains midline on tongue or falls into sulcus.

Reduced buccal tension

  • Patient Description
    • Cannot chew
    • Avoid foods requiring mastication
  • Clinical Symptom
    • Materal falls into sulci
  • Radiographic Symptom
    • Materal falls into sulci

Reduced tongue coordination to form bolus (after mastication)

  • Patient Description
    • Material goes all over mouth
    • Food catches in mouth
  • Clinical Symptom
    • Material spreads around oral cavity.
  • Radiographic Symptom

Reduced oral sensation

  • Patient Description
    • Material goes all over mouth
    • Food catches in mouth
  • Clinical Symptom
    • Material spreads around oral cavity.
  • Radiographic Symptom
    • Loss of bolus control: material spreads around oral cavity.

Reduced tongue coordination to hold bolus (c5) (for liquids and paste materials).

  • Patient Description
    • Coughing, choking before the swallow
    • Food catches in mouth
  • Clinical Symptom
    • Coughing, choking before the swallow
  • Radiographic Symptom

Reduced tongue elevation

  • Patient Description
    • Food catches in mouth.
    • Slow eating, worse with solids.
  • Clinical Symptom
    • Slow oral transit times
  • Radiographic Symptoms
    • Slow oral transit times
    • Reduced tongue elevation
    • Collection of material on the hard palate

Reduced anterior to posterior tongue movement

Swallow apraxia (Disorganized anterior to posterior tongue movement. Repeated tongue pumping)

  • Patient Description
    • Slow eating
  • Clinical Symptom
    • Slow oral transit times
  • Radiographic Symptom
    • Slow oral transit times

Scarred tongue contour

  • Patient Description
    • Slow eating
  • Clinical Symptom
    • Slow oral transit times
  • Radiographic Symptoms
    • Slow oral transit times
    • Collection of material in tongue depression from scarring, worsened with tongue movement.

Delayed pharyngeal swallow (c6)

  • Patient Description
    • Food catches at base of tongue, high in throat
    • Food coughed up
    • Coughing, choking
  • Clinical Symptoms
    • Delayed elevation of hyoid bone and thyroid cartilage
    • Expectoration of material before the pharyngeal swallow
  • Radiographic Symptoms
    • Hesitation of material in the valleculae prior to initiation of pharyngeal swallow
    • Aspiration before swallow
    • Expectoration of material before the pharyngeal swallow
  • Video Sampel
    • Pt 17 (CVA, Delayed response, Reduced P contraction)
      • Paste Bolus
      • Mild reduction in tongue function with repeated tongue pumping
      • Residue in valleculae & along back & base of tongue after swallow
      • Dry swallows to clear residue
        • Residue still remains - indicative of reduced p. contraction.

Absent pharyngeal swallow

  • Patient Description
    • Food does not go down
  • Clinical Symptoms
    • No hyoid/thyroid elevation
    • Slow oral transist times
  • Radiographic Symptom
    • Hesitation of material in the valleculae, with potential spill over into pyriform sinus and/or airway

Reduced pharyngeal contraction (c2) /tongue base movement (c9)

  • Patient Description
    • Coughing, choking
    • Food coughed up
  • Clinical Symptom
    • Coughing, choking after the pharyngeal swallow
  • Radiographic Symptom
  • Video Case
    • Pt 14 (CVA-Reduced contraction)
      • Cookie
      • Reduced pharyngeal contraction
        • After swallow residual food on tongue base and valleculae which collects in pyriform sinus.

Reduced laryngeal elevation (c7)

  • Patient Description
    • Coughing, choking
    • Food coughed up
  • Clinical Symptom
    • Expectoration of material after the pharyngeal swallow
  • Radiographic Symptom
    • Residue of material in the pyriform sinus after the swallow
    • Residue at top of airway
  • Video Sample
    • Pt 18 (CVA w/ tracheostomy tube, Reduced Laryngeal Elevation)
      • Reduced laryngeal elevation in presence of excellent airway closure
      • The vocal folds close, but epiglottis does not, due to reduced laryngeal elevation.
      • Has excellent vf closure during swallow, but aspirates after swallow when he opens airway to inhale.
      • Reduced laryngeal elevation results in residue in area of laryngeal vestibule because larynx is too low and collects food during swallow.
        • Because larynx is not elevating well, cricopharyngeal region does not open as widely and there is residue in pyriform sinuses.

Unilateral (c10) or bilateral pharyngeal paralysis. Reduced tongue base movement.

  • Patient Description
    • Food sticks high in throat
  • Clinical Symptom
    • NA
  • Radiographic Symptoms
    • Residue of material on one or both sides of valleculae or pyriform sinus
    • Aspiration after swallow

Cricopharyngeal dysfunction/Reduced laryngeal elevation (c1)

  • Patient Description
    • Coughing, choking
    • Material catching at bottom of throat
  • Clinical Symptoms
    • Coughingm choking after the swallow.
    • Gargly voice quality
    • Excessive secretions
  • Radiographic Symptoms
    • Aspiration after swallow
    • Collection of material in pyriform sinuses
    • Prominant pharyngoesophageal segment
    • Spillover form valleculae
  • Video Samples
    • Pt 16 (Spinal Cord Injury, Reduced P contraction, CP Dysfunction)
      • Liquid
      • Mild amount of residue in valleculae and posterior pharyngeal wall
      • Result of reduced pharyngeal contraction
      • Nasogastric tube in place
      • Mild cricopharyngeal dysfunction
      • Residual material lies on pharyngeal wall after paste swallow.
      • Residual gradually works its way toward the airway.
      • Dry swallows to clear residue
        • Delayed response
    • Pt 22 (CVA, Cricopharyngeal Dysfunction)
      • Cricopharyngeal dysfunction
      • Food does not penetrate upper esophageal sphincter into esophagus
      • Aspiration after swallow because food collected in pyriform sinuses is sucked into airway when pt inhales after swallow.
    • Pt 23 (CVA, Cricopharyngeal Dysfunction)
      • Oral and pharyngeal swallow normal
      • Residue in pyriform sinuses
      • Repeated dry swallows, pt drives residue into esophagus.
      • Head turned to left (damaged side) clears right pyriform sinus.

Reduced esophageal peristalsis or other esophageal disorder

  • Patient Description
    • Coughing, choking
    • Material catching at bottom of throat
  • Clinical Symptoms
    • Coughingm choking after the swallow.
    • Gargly voice quality
    • Excessive secretions
  • Radiographic Symptoms
    • Aspiration after swallow
    • Collection of material in pyriform sinuses
    • Prominant pharyngoesophageal segment

Reduced esophageal peristalsis or other esophageal disorder

  • Patient Description
    • Coughing, choking
    • Material catching at bottom of throat
  • Clinical Symptoms
    • Coughingm choking after the swallow.
    • Gargly voice quality
    • Excessive secretions
  • Radiographic Symptoms
    • Aspiration after swallow
    • Collection of material in pyriform sinuses
    • Prominant pharyngoesophageal segment

Esophageal diverticulum

  • Patient Description
    • Coughing, choking after the swallow
    • Regurgitation of food
  • Clinical Symptoms
    • Regurgitation of food
    • Coughing, choking after swallow
  • Radiographic Symptoms
    • Collection of material in side pocket in the pharynx or esophagus.

Partial or total obstruction in esophagus

  • Patient Description
    • Coughing, choking after the swallow
    • Regurgitation of food
  • Clinical Symptoms
    • Regurgitation of food
    • Coughing, choking after swallow
  • Radiographic Symptoms
    • Collection of material in side pocket in the pharynx or esophagus
    • Aspiration after the swallow from esophageal "overflow"