Swallowing Exam #1

Buccal scarring can occur as a result of oral surgery

true

Buccal means

cheek

T/F An MBSS can also be referred to as a cookie swallow

true

T/F If a patient denies a swallowing disorder, the reports are usually accurate

false

When we have a triggering of the swallowing reflex that takes place, what physiological activities occur

velum elevates, false and true vocal folds close; aryepiglottic folds close; epiglottis inverts, larynx and hyoid bone move up and forward, pharyngeal peristalsis starts, and cricopharyngeus muscle of the upper level of the esophageal sphincter opens

If a person has reduced range of lateral tongue movement, what problems might they exhibit

pocketing of food, unable to tongue sweep, moving bolus between both sides of teeth while chewing

The area between the base of tongue and the epiglottis is known as the

valleculae

Piecemeal deglutition

bolus is divided into two or more swallows

What should a modified barium swallow study report include

any aspiration, reason for aspiration, residue (oral, valleculae, pyriform sinus), diet recommendations

Following a MBSS, a therapist may ask the patient to say /ah/. Why would they do this?

checking for a gurgly voice quality, to see any particulate matter or residue is on the vocal folds

Dysphagia

difficulty/inability to swallow

What is the purposes of eating

Pleasure and nutrition

Difference between feeding and swallowing

feeding manipulation in mouth before initiation of the swallow (oral preparatory and oral stage) and plate to mouth; swallow is all of them including the actual swallow

List three professions that may be on the dysphagia team

dietician, nurse, radiologist

When might your bring in an OT or PT to a dysphagia team

patient can't go plate to mouth; patient has trouble posturing

Aspiration

food penetrates the laryngeal vestibule goes past the level of the vocal folds

Silent aspiration

when patient aspirates without coughing or clearing throat automatically

How long is the oral transit time

one second

What is the result of reduce pharyngeal peristalsis

pharyngeal residue causing aspiration after the swallow

What are two things you can observe in a bedside swallow evaluation

positioning within bed, cognition (level of alertness)

During an oral mech exam. The SLP evaluates the tongue, lips cheeks and soft palate. What are the different parameters they are looking for

ROM, strength, coordination, rate, accuracy

Describe the esophageal stage

upper esophageal sphincter contracts and bolus moves through the esophagus to the stomach in a series of peristaltic waves

Describe the oral transport stage

tongue pushes the bolus against the palate, past the fascial arches, moving it in a backward direction toward the pharynx

Describe the oral preparatory stage

chewing food and forming the bolus by mixing it with saliva

When does the pharyngeal stage start

when it passes the fascial arches

Facial nerve function

movement of facial muscles

Vagus nerve function

elevation of palate, taste, elevation pharynx and larynx

Hypoglossal nerve function

movement of tongue

Trigeminal nerve function

tactile face sensations, movement of muscles for chewing

Symptom, radiographic information, or abnormalities in anatomy or neuromuscular functioning. Patient points "it feels like the food is getting caught in my throat

symptom

Symptom, radiographic information, or abnormalities in anatomy or neuromuscular functioning. Decreased strength and range of motion noted in the right side of the tongue.

abnormality

Symptom, radiographic information, or abnormalities in anatomy or neuromuscular functioning. Residue noted in the valleculae and pyriform sinuses that clear with a repeat swallow.

radiographic

If a patient spits out food from their mouth, what physiological information can you gather?

tongue thrust, reduced tone or strength in lips

If a patient has pocketing of food lateral or anterior sulcus, what physiological information can you gather?

buccal muscles have scarring or neuromuscular impairment

If a patient has collection of food on the hard palate, what physiological information can you gather?

tongue tie or trouble elevating tongue anteriorly

What does coughing or choking indicate?

aspiration

If a patient's swallow reflex is entirely absent, what are the two behaviors that will result

vomiting/spitting out food or aspiration

What is a diverticulum

balloon like section in the pharyngeal or esophageal musculature that pockets food like a pouch

Tracheoesophageal fistula

hole between the trachea and esophagus

Cervical osteophyte

piece of bone from the cervical vertebrae that protrudes into the posterior pharyngeal wall

What happens when someone has a lax cricopharyngeus (upper esophageal sphincter)

reflux

Aspiration before, during, or after the swallow. Inadequate pharyngeal peristalsis.

after

Aspiration before, during, or after the swallow. Failure of three sphincters of larynx to close.

during

Aspiration before, during, or after the swallow. Poor tongue control or coordination.

before

What is it called when food falls over the base of the tongue and into the valleculae before the swallow?

premature spillage

Aspiration before, during, or after the swallow. Hypertonicity of the cricopharyngeus muscle.

after

Aspiration before, during, or after the swallow. Delayed swallow.

during

When does an SLP a blue dye test?

dye a thin liquid to drink for patients with tracheostomies and suction out the liquid to see if there is residue

When does an SLP use the FEES?

look at the pharyngeal and laryngeal portion of swallow

What are the benefits to using a FEES.

can see the swallow in motion, no radiology

Why might someone not tolerate the FEES

sensitivity in their nose.

When does an SLP use a manometry

swallow tubes to look at peristalsis

When does an SLP use an acoustic analysis

uses stethoscope to study the different parameters of swallowing

T/F Esophagus consists of a hollow tube 30 to 45 cm long with a sphincter only at the upper end

false

T/F Oral transitory stage of the swallow usually takes less than one second

true

T/F Airways close during the oral stage of the swallow.

false

T/F In normal swallows, the bolus moves quickly and smoothly over the base of the tongue and through the pharynx.

true

T/F The chances of aspiration decrease if material reaches the pyriform sinuses before the swallow reflex is triggered.

false

T/F Coordinated tongue movements is required to pull material into a cohesive bolus.

true

T/F MBSS is designed to determine not only if the person is aspirating, but also why they are aspirating.

true

What can we use the information from an MBSS to determine?

diet consistencies and NPO or not, type of treatment needed, anatomical or physiological structures aren't functioning well

What are some pieces of data about a tongue thrust

causes food to come out front of mouth, causes poor labial closure, initiates swallow with their tongue tip going forward to incisors

Do we typically record MBSS?

yes

What does barium do in an MBSS?

coats the food so we can see it in the x-ray

Who is responsible for taking the picture in an MBSS?

radiologist

Can both the oral and pharyngeal stage be visualized in an MBSS?

yes

Define the anticipatory stage of swallow

salivation, smelling food, feeling hungry

The triggering of the swallow reflexes causes the larynx to elevate and move forward. Why is this an important safety function?

so food doesn't go into the airway by moving it out of the way and opening the esophagus

List two changes that occur to the normal swallow when a person becomes elderly.

reduced peristalsis, increased mastication

You are performing an oral mech exam. What are some tasks to ask the patient to do to assess the function of the tongue.

protrude, retract, lateral movements

You are performing an oral mech exam. What are some tasks to ask the patient to do to assess the function of the lips

pucker, smile

You are performing an oral mech exam. What are some tasks to ask the patient to do to assess the function of the soft palate

/ah, ah, ah/

You are performing an oral mech exam. What are some tasks to ask the patient to do to assess the function of the laryngeal functioning

cough, hard glottal stops

Larynx closes to prevent food from entering the ___

airway

The bolus moves from the esophagus to the stomach in a series of __________

peristaltic waves

The topmost structure of the larynx is the epiglottis which rests against the base of the ____

tongue

When an individual is finished masticating the food, the tongue forms a central grove which acts as a ____ for the food to pass through it to move more posteriorly.

shute

Greater the reduction in tongue elevation, the greater the chance of ____________.

premature spillage

A _____ tracheostomy tube is placed when there is a potential for the patient to aspirate material.

cuffed

If a person is having difficulty producing voice with a normal tracheostomy tube, a _____ or window may be cut into the tube to allow for greater airflow

fenestration

Difference between inner cannula and outer cannula of the tracheostomy tube

outer cannula stays in and has the face plate connected to it, outer cannula can be fenestrated; inner cannula can be removed for cleaning and suctioning

Swallowing strategies overview. Chin tuck or head tilt forward.

widens vallecular space; used for delayed swallows

Swallowing strategies overview. Head tilt backward.

poor oral transit time with a good pharyngeal and laryngeal transit time (ex. oral cancer patient)

Swallowing strategies overview. Turn head to side.

weak pharyngeal peristalsis on one side (turn to weak side)

Swallowing strategies overview. Head tilt to side.

head to stronger side to help in the oral and/or the pharyngeal cavity

T/F The oral stage of the swallow is considered to be voluntary

true

T/F The valleculae and pyriform sinuses are side pockets into which food may fall before or after the swallow reflex is triggered

true

T/F The medulla carries out and regulates life sustaining functions such as breathing, swallowing, and heart rate.

true

T/F MBSS involves the examination of the entire length of the esophagus.

false

T/F Food is collected into a bolus following the initiation of the swallow reflex.

false

T/F Another name for the upper esophageal sphincter is the cricoesophageal muscle.

false

T/F The longer the delay in triggering the swallow reflex, the greater the chance the patient will aspirate in part or all of the bolus.

true

T/F Clinicians have no way of examining aspiration definitively using only a bedside swallowing evaluation.

true