SWALLOWING: HOW CAN WE HELP Carol Romero-Clark, M.S., CCC-SLP University of New Mexico Hospital Speech Pathology Department November 10, 2017
What happens when you swallow? Mouth (Oral Phase) Your tongue touches the roof of your mouth and pushes the food back toward the throat, then you swallow Chewing involves tongue movement from side to side and around to mash the food Lips stay closed when you swallow Jaw only moves when you chew. Stays closed when you swallow
What happens when you swallow? Cont. Throat (Pharyngeal Phase) Voice box moves upward and forward when you swallow You have a brief moment when you do not breathe Your bell in your throat lifts and closes to stop food from going in your nose Your throat muscles squeeze together to push the food down into your food tube You should feel all the food or liquid pass into your food tube No coughing, choking, or feeling of strangulation Voice is clear
What happens when you swallow? Cont. Food Tube/Esophagus Your upper muscle opens to let food into the esophagus Muscles of your food tube push the food down into the stomach
What does it mean when you can t swallow? Mouth Your tongue doesn t push the food backward well You have lots of food or liquid left in your mouth after your swallow Your tongue pushes forward and you swallow air Your jaw stays open and you can t push the food back Your tongue doesn t move well enough to chew You start choking on food before you swallow Food or liquid drips out of your mouth; you can t hold it in
What happens when you can t swallow? Cont. Throat Your throat muscles can t push the food passed your throat Food feels like it gets stuck You feel like you are choking You swallow 3 or more times to clear your throat You cough during or after you swallow Water doesn t help to wash the food down
What happens when you can t swallow? Food Tube (Esophagus) Feels food sticks in your chest Food doesn t want to go down Feel your food or liquid comes back up Feeling of heartburn Can t lie down after you eat Swallow many times but can t force it down
What do we do about it? Swallow Tests
Different Food Types Given Thin liquids Nectar liquids Thin Puree (applesauce) Thick Puree (pudding) Solids
Test #1 Clinical Swallow Evaluation Seen in the clinic Watch you swallow different types of food Feel for the movement of your voice box when you swallow Try different ways to help you swallow better Decide if we need another test
Test # 2 Flexible Endoscopic Evaluation of Swallowing Place a scope in your nose Watch you swallow with the scope in your nose All foods are dyed green Watch the movement of your voice box and throat when you swallow
FEES - Normal
FEES - Abnormal
Test #3 Videofluoroscopic Swallow Study X-ray Study Allows us to watch the mouth, throat and esophagus work together Can see where the food or liquid is going Can see if liquids are entering the windpipe Helps us decide if a botox injection or dilation is needed to help swallow Swallow a special liquid called barium to help us see when the food is going
Videofluoroscopic Swallow Study Swallow Study Sit between the x-ray table and camera Different food types will be given Different positions will be viewed Side Front to back
Liquids we give you
Normal Swallow
Problems with the Mouth
Problems with the Throat
Esophagram Lay on your stomach with knees bent Table slightly angled Swallow barium (liquid) through a straw Esophagram
Esophagram Normal
Esophagram Abnormal
Why do we do swallow studies? Find the safest way for you to swallow Make sure you get proper nutrition Improve the efficiency of your swallowing Determine what treatment option is best for you Quality of life
Can we fix it or make it better? Try different head positions Chin tuck Head turn (L or R) Head tilt
Other things to try Close your mouth when you swallow and push on the roof of your mouth when you swallow Dilation, botox, or myotomy then swallowing assistance with speech therapist Diet changes Feeding tube
Esophageal Dilation Stretches the upper muscle Goal is to open upper muscle to allow the food to pass easier Bougie or Balloon dilation
Botox Injection Inject botox in the muscle to relax the muscle Performed by ENT
Myotomy of Upper Muscle Surgical procedure to cut the muscle Permanent procedure Performed by ENT
Heartburn or Acid Reflux Medications Omeprozole, pantroprozole Ranitidine Other ways to control heartburn
Reflux Precautions Things you can change at home Lifestyle changes Can be combined with medications for reflux management