Wednesday, January 25, 2012

Dysphagia, Anyone?

Swallowing requires a complex chain of events; most of which are "automated," meaning that no thought is required for swallowing once swallowing is initiated.  The swallowing center of the brain is connected to the pharynx (part of the throat situated directly behind the mouth and nasal cavity) and esophagus (a flap of elastic cartilage attached to the back end of the tongue) via a superhighway of nerves.  These connections enable reflexes that enable proper swallowing.

To get a sense of all that is required for the "simple" skill of swallowing, here is a look at the mechanisms that are involved in making it work:
  1. Food is masticated (chewed) in the mouth and mixed with saliva; forming a bolus (lump of masticated food).  This is the first and only step of swallowing that is not automated.
  2. The bolus is then propelled towards the pharynx.
  3. The soft palate, or the back end of the roof of your moth, is elevated to keep food from entering the nasal passage.
  4. The upper pharynx contracts, pushing the bolus towards the lower pharynx.  At the same time, the larynx (voice box) is pulled forward by muscles in the neck, allowing the epiglottis to bend downwards...this dual action keeps food from traveling into your trachea (windpipe) and larynx.
  5. Contractions of the muscular pharynx propel the bolus further.
  6. The upper esophageal sphincter (muscle at the upper end of the esophagus) relaxes, allowing the bolus to enter the esophageal tube.
  7. A wave of contractions allow the bolus pass through the entire length of the esophagus.
  8. The lower esophageal sphincter, relaxes so that when it arrives the bolus can pass on into the stomach.
The medical term for any difficulty or discomfort when swallowing is dysphagia.  If you find it difficult to swallow, the problem can occur at any one or more of these stages.  Premature babies, the elderly, stroke and Alzheimer's sufferers, traumatic brain injury patients along with individuals with throat and neck cancer can all suffer with swallowing disorders. 

So, whats the big deal if you have a swallowing disorder?!  One of the most eminent concerns of dysphagia is aspiration where food/liquid travel into the trachea and lungs.  If you aspirate a particularly large piece of food, you face the life-threatening danger of airway obstruction.  While the aspiration of smaller particles of food or liquid pose less of a threat to the airways, they can lead to infection.  Some lesser threatening consequences include: weight loss, dehydration, malnutrition, failure to thrive and social withdrawal.  All of which can have a detrimental impact on your quality of life.  Reach out to your speech pathologist for assessment, diagnosis and treatment for dysphagia

Until next time,
Salima Dhamani M.S., CCC-SLP

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