Entry #582988, added on 05-03-08 @ 12:28 am EDT
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Swallowing is so automatic that we usually swallow several times a minute without even thinking about it. It happens in several stages, each one a complicated set of muscle movements that rely on split-second timing.
The oral phase begins when food or liquid is taken into the mouth. The lips seal together tightly and the teeth chew. The tongue moves the material around, forming it into a bolus, or ball shape. It then pushes against the roof of the mouth, dumping the bolus back into the throat.
The pharyngeal phase begins as the bolus passes the base of the tongue and the swallow reflex is triggered. This reflex tightly closes the vocal folds, or vocal cords, to protect the airway.
In the esophageal phase, the band of muscle at the top of the esophagus stretches open to admit the bolus. Sections of the esophagus contract sequentially to squeeze the bolus down to the stomach. The bolus can take up to half an hour to travel the whole distance.
If any of the muscles are weakened or any of the nerves are less sensitive because of injury or disease, swallowing can become disordered. This is called dysphagia. For example, a stroke may limit the movement of the tongue in the oral phase, and food builds up in one side of the mouth because it cannot be added to the bolus. Dental problems may prevent someone from chewing food well. In the pharyngeal phase, the vocal folds may not close tightly, allowing food or liquid to leak into the airway (aspiration). The swallow reflex may be uncoordinated, and the bolus may begin traveling into the throat before the airway is protected. In the esophageal phase, the movement of the esophageal muscles may be too weak to move the bolus to the stomach, or may actually move the wrong direction.
Treatment for dysphagia typically focuses on diet modifications, compensatory strategies, and direct treatment. Diet modifications may include giving a diet of soft or pureed food to someone who has trouble chewing. Someone who has a delayed swallow reflex may be given only certain types of liquids to prevent aspiration. In extreme cases, oral feeding is not recommended and a feeding tube may be placed directly into the stomach. Compensatory strategies may consist of positioning, breathing, and swallowing techniques to make up for the weakened muscles. Direct treatment focuses on remediating the dysfunctional muscles and nerves with exercises, sensitization training, and other techniques.
For more detailed information on swallowing problems and on topics such as developmental swallowing problems, please visit http://www.asha.org/public/speech/swallowing/.
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