Understanding Dysphagia: Oral, Pharyngeal, and Esophageal

Introduction

• Dysphagia refers to difficulty swallowing, and it's crucial to identify which phase of swallowing is impacted.
• This talk focuses on three phases of dysphagia: oral, pharyngeal, and esophageal. These aren't separate phases, but rather a continuum.
• Speaker: Theresa Richard, medical speech pathologist and founder of Med SLP Collective.

Oral Dysphagia

• Definition: Issues in the oral phase, involving lips, tongue, jaw, or other oral structures.
• Assessment Tools: Modified Barium Swallow Impairment Profile (MBSIMP) assesses 17 swallowing components.
  • Oral components include lip closure, tongue control, bolus preparation, mastication, and transport.
• Symptoms and Causes:
  • Poor lip closure can cause anterior bolus loss.
  • Stroke, Bell's Palsy, oral cancer, Parkinson's disease are potential causes.
• Treatment Approaches:
  • Depends on the specific impairment and cause.
  • Compensatory strategies and exercises may be used.
• Case Study Example:
  • Patient with cerebral palsy benefitting from a 45-degree angle positioning during swallowing.

Pharyngeal Dysphagia

• Definition: Impairments in pharyngeal and laryngeal structures affecting bolus transit and airway protection.
• Assessment Tools: MBSIMP measures components like laryngeal elevation, epiglottic movement, and pharyngeal contraction.
• Symptoms and Causes:
  • Reduced laryngeal closure can lead to aspiration.
  • Structural, neurological, or strength/motor deficits.
• Assessment and Diagnosis:
  • Instrumental exams like FEES or video fluoroscopy are necessary.
  • Bedside evaluations are not sufficient for diagnosis.
• Case Studies:
  • Patients showing unexpected results during instrumental exams highlight the need for thorough assessment.

Esophageal Dysphagia

• Definition: Impairment in the esophagus affecting swallowing, often causing the sensation of food being stuck.
• Causes:
  • Commonly linked to conditions like GERD.
  • Other causes include esophageal diverticulum, esophagitis, and Schatzki's ring.
• Role of SLPs:
  • SLPs can assess the connection between oral/pharyngeal symptoms and esophageal causes.
  • SLPs should communicate findings to medical teams and suggest GI referrals.
• Challenges:
  • Issues with capturing esophageal sweeps during video fluoroscopy due to differing priorities with radiologists.
  • Importance of differentiating between a screening tool and a diagnostic tool.

Conclusion

• Dysphagia is a complex condition with distinct phases that require tailored assessment and intervention.
• SLPs play a critical role in diagnosing dysphagia phases and coordinating care with other medical professionals.
• Additional resources are available at the Med SLP Collective for further learning and support.