Anatomy
Another term for the Pharyngoesophageal Segment (PES)
UES (Upper Esophageal Segment)
A patient exhibits significant residue in the valleculae after swallowing. This is indicative of a dysfunction in which phase?
The pharyngeal phase.
During a bedside swallow evaluation, a patient coughs immediately after drinking water and has a wet vocal quality. What is the most likely cause?
Reduced pharyngeal phase swallow efficiency (like aspiration or penetration)
A patient with Parkinson’s disease presents with a significant swallowing delay and pharyngeal weakness. Which technique is most appropriate to improve airway protection during the swallow?
Mendelsohn Maneuver or Chin tuck technique
A clinician is assessing a patient for a suspected swallowing disorder. The patient has a tracheostomy tube. Which assessment method is the most appropriate to determine the patient's candidacy for a one-way valve?
Assessing the ability to pass air to the oral cavity with expiratory occlusion.
What structure forms the lower boundary of the nasopharynx:
Soft palate/velum
The pharyngeal stage of the swallow is considered to begin at the level of the ________ and ends when the ________ closes.
The disordered phase of swallowing that is characteristic of delayed/absent swallow reflex, premature swallow/aspiration.
Pharyngeal Phase
What is the primary goal of the "Masako Maneuver" (Tongue Hold)?
To increase posterior pharyngeal wall (PPW) anterior bulging to compensate for reduced base of tongue retraction. (Don't do this with a bolus--just as an exercise.)
A patient with severe oral weakness is unable to manage thin liquids. Which of the following is the most appropriate modification?
Thickening liquids
Which muscle is primarily responsible for the elevation and retraction of the velum to prevent nasal regurgitation during the pharyngeal phase?
Clue: Itsy Bitsy Teeny Weenie
Levator Veli Palatini
Oropharyngeal dysphagia in a child with Down syndrome is most likely caused by...Oral motor behavior, velopharyngeal function, laryngeal function, or phonological awareness
Velopharyngeal function
Oropharyngeal dysphagia in a child with Down syndrome is most likely caused by which of the following factors? Cleft of the hard palate, aversive feeding behaviors, hypotonia, or macroglossia alone
Hypotonia
A clinician recommends the "Effortful Swallow" to a patient with reduced pharyngeal clearance. What is the primary physiological goal of this maneuver?
To increase Posterior Pharyngeal Wall (PPW) movement and Base of Tongue (BOT) retraction, thereby increasing the pressure exerted on the bolus to clear pharyngeal residue.
A patient has a suspected, but not confirmed, aspiration issue. What is the most appropriate instrumental assessment to confirm or rule out aspiration?
MBS or FEES
The "Upper Esophageal Sphincter" (UES) is a complex circular muscle. Which muscle forms the main body of the UES?
Cricopharyngeus
Which cranial nerve primarily mediates sensation to the face and motor stimulation to the jaw?
Trigeminal (CN V)
A patient presents with residue in the pyriform sinuses after the swallow. What is the most likely physiological deficit?
Reduced UES opening caused by poor hyolaryngeal anterior excursion or cricopharyngeal dysfunction.
What is the primary difference between a "Compensatory Strategy" and a "Rehabilitative Exercise" in dysphagia management?
A Compensatory Strategy (e.g., Chin Tuck, Head Rotation, Liquid Wash) is a temporary fix that alters the flow of the bolus to ensure safety during the meal. A Rehabilitative Exercise (e.g., Shaker Exercise, Masako) is designed to permanently change the swallow physiology through muscle strengthening or neuroplasticity over time.
A 73-year-old man who recently suffered a stroke is currently receiving nutrition via a nasogastric tube. During a bedside exam, he presents with drooling, a gurgly voice, and a weak cough. What is the most appropriate next step?
Refer for instrumental assessment (MBS)
Which cranial nerve provides sensory innervation to the base of the tongue and the supraglottic larynx, triggering the swallow reflex?
CN IX (glossopharyngeal) for the tongue base and faucial pillars and CNX (Vagus) for supraglottic laryngeal mucosa
During the pharyngeal phase, what is the primary physiological driver of "Hyolaryngeal Excursion"
Contraction of the Suprahyoid muscles (Geniohyoid, Mylohyoid, and Anterior Belly of the Digastric), which pulls the hyoid bone anteriorly and superiorly.
If a patient exhibits "vallecular residue" following a swallow, which physiological movement is likely impaired?
Reduced Base of Tongue (BOT) retraction or reduced epiglottic inversion.
For a patient with "Unilateral Pharyngeal Weakness" (e.g., following a right-sided medullary stroke), which postural compensation is most effective for clearing residue?
Head rotation/turn toward the weak side to "close off the damaged side of the pharynx, channeling the bolus down the stronger side.
In a Modified Barium Swallow Study (MBSS), which view is best for visualizing the symmetry of residue in the pyriform sinuses?
Anteriorposterior view