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.
