Swallowing is commonly described as having four
different phases. Actually, these phases
overlap and are influenced by different variables
(such as the amount and what you are swallowing).
These phases are typically referred to as the
1) oral preparatory phases, 2)oral phase, 3) pharyngeal
phase, and 4) esophageal phase. During the oral
preparatory and oral phases, food and
liquid are brought to and contained within
the mouth, tasted and prepared through chewing
and mashing, and delivered to the back of the
mouth. Individuals with impaired sensation
or weakness of the structures of the mouth can
experience difficulty keeping food in the mouth,
preparing the food to be swallowed, delivering
the food to the throat, and completely clearing
food from the mouth after swallowing.
The pharyngeal phase occurs as the food
or liquid reaches the back of the mouth and an
actual "swallow" response occurs.
During the normal pharyngeal swallow phase, the
soft palate closes the nose from the mouth to
prevent food and liquid from entering the nose,
the airway closes and is protected and food is
propelled through the throat by pressure and muscle
contractions. During this phase, problems
can include difficulty getting the swallow started,
inability to close and protect the airway during
swallowing, trouble sealing the mouth from the
nose, and difficulty propelling food through the
throat into the esophagus.
During the esophageal phase, food is delivered
through the esophagus to the stomach through gravity
and peristaltic, squeezing muscle contractions.
Esophageal disorders can include reflux, narrowing
of the esophagus, and impaired muscle contractions
of the muscles lining the esophagus.
Aspiration, or entry of food or liquid into the
airway, can occur before, during, or after the
swallow. Aspiration before the swallow can
occur in individuals with poor tongue or oral
control and in those with a delayed, slow swallow
response. In the case of faulty closure
or impaired valving action of the larynx during
swallowing, aspiration can occur as the swallow
takes place. If food or liquid is retained
within the mouth or throat after the swallow,
due to poor strength and control of the muscles
of the mouth and throat, one can aspirate after
the swallow has occurred.
Treatment
Following a thorough evaluation,
in some cases, treatment requires direct medical
or surgical intervention by the physician.
Therapy may also be recommended depending on the
nature of the disorder. Therapy may include
physiotherapeutic exercise to strengthen the swallowing
musculature, modification of diet textures, and
instruction in strategies and maneuvers to compensate
for the swallowing problem.
Therapy at Saint Joseph’s Evelyn Trammell
Center is performed by a licensed, certified speech
pathologist with special skills and knowledge
in the area of swallowing and swallowing disorders.
The swallowing therapist can coordinate efforts
with other professionals including the physician,
dentist, nurse, dietician, occupational therapist,
physical therapist nutrition support specialist,
and any others involved in the care of the person.
The goal of treatment is to return the individual
to safe, effective swallowing to ensure good health
and optimal nutrition.
