Deglutition Oropharyngeal Dysphagia
Understanding Deglutition Oropharyngeal Dysphagia Function
Oropharyngeal swallowing function & dysphagia
Abnormalities of swallowing, or oropharyngeal dysphagia, are defined as difficulty in initiating an oral swallow and may be complicated in severe instances by aspiration (and aspiration-associated pneumonia) and malnutrition (with weight loss). Such dysphagia is common, in that one in 17 people will develop some form of oropharyngeal dysphagia in their lifetime, 1 million patients are diagnosed with dysphagia per year in the U.S., and roughly 60,000 patients will die each year in the U.S. from complications of dysphagia.
Understanding oropharyngeal dysphagia & aspiration pneumonia: Role of the tongue
Oropharyngeal swallowing is an innate and precisely orchestrated set of physiological events with a simple goal: to transport ingested food from the mouth to the esophagus. This process involves a tightly integrated set of actions involving the muscles of the oral cavity, pharynx, larynx and laryngeal closure, upper esophageal sphincter, and timely regulation of respiratory timing.
Central to this process is the force-generating deformation and displacement of the tongue, a versatile and structurally complex muscular organ Following ingestion, food is modified through a set of actions incorporating motions of the tongue, hyoid, and mandible to configure and transport food or liquid to the pharynx.
After swallow initiation, the larynx moves superiorly and anteriorly while undergoing vestibular closure, thus producing a cylindrical flow chamber for bolus transport towards the esophagus. The tongue participates in the manipulation of the bolus within the oral cavity, propulsion of the bolus via the pharynx into the esophagus, and protection of the airway during swallowing. (Figure 1)
Simultaneously, the tongue base places pressure on the bolus with a posterior and inferior wavelike movement to promote clearance to the pharynx. Aspiration may be attributed to fragmentation of the bolus of food, which affects cohesion of the bolus and time that the passing bolus is potentially exposed to an open or partially open airway. Aspiration is defined by the coincidental presence of the passing bolus, an open or partially open airway, and inspiration.
Role of the tongue in oropharyngeal swallowing
Swallowing is an innate and precisely orchestrated set of physiologic actions with the net goal of transporting food from the mouth to the esophagus. The tongue is principally responsible for carrying out a set of purposeful deformations that first encompass and then propel the ingested food bolus from the mouth to the esophagus. Shown here are the characteristic changes of tongue shape that are essential for swallowing, with liquid bolus and the tongue shown by blue arrows.
Symptoms of oropharyngeal dysphagia
You May Experience Symptoms Of:
- Impaired swallowing initiation: Inability to start a swallow or food sticking in the throat.
- Impaired swallowing initiation: Inability to start a swallow or food sticking in the throat.
- Airway dysfunction: Coughing, choking, or gagging immediately before, during, or after swallowing.
- Abnormalities of oromotor control; Drooling, difficulty chewing.
- Voice and Throat Changes: Hoarse voice or frequent throat clearing.
- Nasal Regurgitation: Food or liquid coming back through the nose.
- Physical Complications: Significant weight loss, dehydration, or recurrent chest infections.
Common Causes Of Oropharyngeal Dysphagia:
- Neurological disorders: Stroke, Parkinson’s disease, dementia, and head injuries.
- Structural issues: Blockages like oral or pharyngeal tumors, Zenker’s diverticulum (a pouch in the throat), or bony growths on the spine.
- Treatment side effects: Swallowing issues can result from radiation therapy for head and neck cancer or modifications of the oral or pharyngeal cavities due to surgical resections or reconstructions.
Diagnosis & treatment
- Speech-Language Pathologists (SLPs), ENT physicians, and gastroenterologists are the primary specialists for evaluating and treating this phase of swallowing.
- "Gold standard" tests include videofluoroscopy (VFS) and fiber-optic endoscopic evaluation of swallowing (FEES), as well as tests of oropharyngeal or laryngeal structure, such as CT scan or MRI.
Frequently asked questions related to oropharyngeal dysphagia
What is the most likely cause of my swallowing difficulty?
Most commonly oropharyngeal dysphagia can be traced to an issue with neurological control or a structural abnormality in the oral cavity, pharynx, or airway. Occasionally, it may be a combination of both.
Is this condition likely to be temporary or permanent?
It entirely depends on its underlying cause and the severity of the problem. Most commonly, oropharyngeal dysphagia can be linked to an underlying neurological disease which may be treated. If treatment is incomplete or not available, it is still possible to reduce the severity of symptoms and minimize the risk of aspiration with swallow therapy.
Do I need to change the texture of my food or drinks right now?
This is certainly a possibility, and, in fact, this is commonly recommended. In circumstances where it is shown that you have difficulties in controlling the way that food travels through your oral cavity and throat, changes to the texture of your food, such as thickening, may be helpful.
Should I be referred to a speech-language pathologist for diagnosis or therapy?
Absolutely. Speech language pathologists (SLPs) are trained specifically in the evaluation of oropharyngeal dysphagia and can perform tests such as videofluoroscopy and endoscopy, as well as assessing the results of anatomical assessments, such as CT scans or MRI, and then initiate swallowing treatment paradigms. The SLP will work in close coordination with head and neck surgeons, radiologists, and gastroenterologists also involved in your care.
How will I know if there is an emergency? What do I do if it is?
There are two areas of urgent concern that may occur regarding oropharyngeal dysphagia.
First, if you are entirely unable to provide food to yourself, you may experience malnutrition, dehydration, or weight loss.
Second, if you are unable to swallow without food entering your airway, a condition that is termed aspiration, you are at risk of developing pneumonia. Both reflect a more serious disease and require urgent evaluation by your physician or SLP.
If either of these circumstances occur, even if you have already initiated treatment, you may require the delivery of nutrition via a gastric tube or via an intravenous source in order to bypass the area of concern.
