How We Swallow

The process of swallowing occurs in four stages:

Oral Preparation stage, in which food or liquid is anticipated and received in the anterior (front) of the mouth in preparation for chewing and eventual swallowing.

Oral Propulsive stage, in which we chew the foodstuffs, formulate a bolus of food or fluid and transit the bolus to the back of the mouth, initiating the swallowing reflex.

Pharyngeal stage, in which food or liquid quickly passes through the pharynx (the canal from the mouth to the esophagus) into the esophagus. The airway is closed and secured by the epiglottis folding over the entrance of the larynx and the closure of the vocal cords.

Esophageal stage, in which the food or liquid moves via the relaxation of the cricopharyngeus muscle and with the peristaltic assistance of the pharyngeal constrictors, through the esophagus into the stomach.

The first two steps are controlled voluntarily, while the latter two steps occur involuntarily. The Interruptions in this process can cause difficulty in swallowing, or dysphagia. A number of conditions may cause dysphagia, including mechanical obstruction (such as by a tumour or stricture), a motility disorder, impairment of the upper or lower esophageal sphincter, and others.
Dysphagia is common among all age groups, but is especially common among the elderly.

Swallowing problems may arise from simple causes such as poor teeth, ill fitting dentures or loss of confidence. One of the most common causes
of dysphagia is gastroesophageal reflux disease (G.E.R.D.), which occurs when stomach acid moves up the esophagus to the pharynx, causing
discomfort. Other causes may include stroke or progressive neurological disorders, which may impair sensitivity, reflex strength or presence, muscular coordination and reduce the individual’s ability to control their bulbar musculature. The presence of a tracheotomy tube, vocal cord paralysis, tumours in the mouth, throat, esophagus or surgery in the head, neck, or esophageal areas may also contribute to swallowing impairment. This process involves the rapid, precise coordination of numerous muscles and tissues of the mouth, pharynx, larynx and esophagus. Any disturbance to this process results in Dysphagia.

What Causes Swallowing Problems?

Aspiration

Aspiration, which is the passage of food or liquid through the vocal folds and into the airway, can be a serious consequence of dysphagia.
It may cause chronic coughing, choking, airway obstruction, and if food/fluid is aspirated into the lungs, aspiration pneumonia.
Aspiration may result from neurological impairment of the bulbar musculature, weakness or incoordination of the pharyngeal muscles, poor opening of the upper esophageal sphincter, or other impairments. In some cases, if a person’s sensation or consciousness is impaired, aspiration does not provoke a cough response, which is a particularly dangerous condition.

Evaluation of Swallowing Problems

If you or your loved one are experiencing difficulties with feeding and swallowing, you can contact your medical professional or us straight away.
Your medical consultant can examine you and address any medical reasons for the swallowing difficulties, including the presence of reflux or metabolic disorder. Melbourne Swallowing Clinics who specialise in treating children and adults with feeding and swallowing disorders can evaluate you and will;

  • Take information regarding your medical history, development, symptoms and current feeding regimes and oral diet.
  • Assess the bulbar musculature; that is the groups of muscles responsible for maintaining a competent swallow.
  • Assess the array of reflexes that should be present to assist in the initiation of a swallow and assist in the protection of the airway.
  • Observe a feeding/ swallowing session to assess your or your child’s posture and positioning, behaviour, oral,
  • pharyngeal functioning and respiratory competency.
  • Advise and counsel you as to any functional changes that can be made to encourage a more competent swallow and
  • improve overall patterning, competence but confidence.
  • Perform special tests, if necessary, to evaluate swallowing competency.

To evaluate swallowing problems, the treating team may recommend

  • Clinical tableside/ Functional assessment
  • Transnasal endoscopy
  • Barium swallow
  • Videofluroscopy Studies