Swallowing dysfunction

Signs and symptoms

What can go wrong?

Oral preparatory

• Reduced lip closure: cannot hold food in the mouth
• Reduced tongue shaping : coordination
• Reduced range of tongue movement: cannot form a bolus
• Tongue thrust
• Lip and jaw weakness: material falls in anterior sulcus and lateral sulcus

Oral

• Residue in anterior and lateral sulcus: reduced lip tone
• Residue in the floor of the mouth 
• Reduced tongue elevation: incomplete tongue-hard palate contraction: residue on the hard palate
• Reduced tongue coordination: piecemeal swallow
• Repetitive lingual rocking and rolling: “tongue pumping”(PD)
• Reduced tongue control and tongue-velum seal: uncontrolled bolus-premature loss of liquid or pudding consistency into the pharynx

Triggering Pharyngeal swallow

·       Delayed pharyngeal swallow: when the head of the bolus enters the pharynx and the swallow has not been triggered: liquids may enter the airway first; no CP opening as no swallow has been triggered: Aspiration before the swallow

·       Timing the delay: in sec

Pharyngeal stage

• Nasal penetration during swallow: reduced VP closure.
• Cervical osteophytes
• Residue laterality (for pharyngeal wall weakness)
• Residue in the valleculae after swallow: reduced tongue base posterior movement
• Residue at the pyriform: reduced laryngeal elevation
• Laryngeal penetration: reduced laryngeal elevation
• Aspiration: during the swallow: reduced laryngeal closure

Oesophageal (usually not assessed-for further referrals)

• Oesophageal-to-pharyngeal backflow
• Tracheo-oesophageal fistula
• Reduced motility

MDT management

Laryngeal function examination

An inability to change the pitch may imply reduced sensitivity within and surrounding the larynx.