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True or False: Spinal Cord Injuries above the level of C5-C6 often impact respiratory and swallowing systems due to diaphragmatic, pharyngeal, and laryngeal innervation
TRUE
How does Chronic Obstructive Pulmonary Disease (COPD) cause dysphagia?
damage to lungs causing inflammation and blockage to airway; increased mucus can clog airways
- disrupts breathe-swallow coordination, poor cough reflex (expiratory pressure), increased risk for aspiration
True or False: Functional Dysphagia has underlying structural or neurological abnormalities.
FALSE
- Related to muscle incoordination, heightened sensitivity, or psychogenic factors
- globus sensation despite no residue/obstruction
How does Post-Radiation Therapy cause dysphagia?
scarring and fibrosis
- stiffened muscles, narrowed swallowing passage
How does a Tracheostomy cause dysphagia?
- weakening of UES / inability to function, reduced laryngeal sensitivity, no pressure buildup (weak cough)
- if cuffed, suction before and after
How does Pill Induced Esophagitis cause dysphagia?
- lining of esophagus inflamed due to medications (type, friction, getting stuck)
- sensitivity making it hard to swallow, swelling, potential scar tissue, narrowed esophagus in severe cases
How does Cerebral Palsy cause dysphagia?
- poor muscle tone (spasticity/weakness) affects oral and pharyngeal muscles
- reduced strength limits chewing/swallowing efficiency
- postural problems
- sensory-motor integration
Three progressive neurological causes of dysphagia
1. Parkinson's disease: progressive degeneration of dopaminergic pathway (hyper/hypokinetic dysarthria - muscle rigidity, bradykinesia (slowed movement), weakness, incoordination)
2. ALS: progressive neurodegenerative disease that affects motor neurons (muscle weakness of swallowing structures (motor, airway protection, timing, clearance)
3. Progressive Supranuclear Palsy (PSP): damage to areas of brain involved with movement and thinking (central pattern generators) (basal ganglia coordination of swallow, brainstem involuntary movements (e.g., peristalsis), cerebellum movement/coordination/timing of structures)
Three autoimmune disease causes of dysphagia
1. Multiple Sclerosis (MS): CNS, attacks myeline sheath (numbness in mouth/throat, globus sensation, longer to finish a meal - affected by change in temperature, fatigue/stress - esophageal dysmotility)2.
2. Myasthenia Gravis: autoimmune condition, nerve & skeletal muscle communication impaired (muscle weakness)
3. Guillain-Barre syndrome: immune system attacks the myelin sheath or axons of peripheral nerves (weakness of muscles, trouble breathing)
How does damage to the Cortex, Cerebellum or Brainstem cause dysphagia?
Cortex: motor planning, voluntary initiation of swallow, sensory impairment; cognitive deficits (attention, memory)
Cerebellum: disrupts motor control, timing of swallow (fragmented bolus transfer, delayed swallow, aspiration pneumonia)
Brainstem: basic functions of CNS - swallow delayed/absent, common silent aspiration, CNXII: weak tongue propulsion
How does Post-Polio Syndrome cause dysphagia?
progressive damage to motor neurons
- muscle weakness
- consider fatigue, work with nutrition
When the upper portion of the stomach pushes up into the hiatus and into the chest.
Hiatal hernia
- higher chance of experiencing blackflow / regurgitation, could cause physical blockage in stomach
- weak LES closure
How does Pharyngoesophageal Reflux cause dysphagia?
LES fails to prevent backflow, exposure of throat and laryngeal tissues to acid and digestive enzymes
- inflammation, thickening of tissues
- globus sensation, delayed swallow initiation, discomfort (odynophagia)
How does Tongue or Laryngeal Cancer causes dysphagia?
Tongue: impacts mastication, bolus control/transport/propulsion, oral residue (glossectomy: partial or total; radiation (fibrosis - stiffening, swelling, damaged salivary glands), cranial nerve damage (motor control / sensation))
Laryngeal: narrows airway, limits airway protection, impaired coordination, vocal fold dysfunction weak/delayed swallow initiation (radiation (fibrosis, edema, stiffness)
Formed with cricopharyngeal muscles (part of UES) fail to relax, fibrotic, and/or stiff
Cricopharyngeal Bar
- reaction to chronic reflux of stomach into esophagus
- impaired UES opening, obstructed bolus flow, pharyngeal pressure increase, globus sensation
What is a ring or circle of extra tissue in the lower esophagus called?
Schatzki's Ring
- feeling of bolus caught in esophagus, food gets stuck, "steakhouse syndrome"
How does liver disease cause dysphagia?
Cirrhosis causes inflammation and fibrous thickening of tissue
- mechanical obstruction: esophagus narrows (globus sensation), can lead to odynophagia (painful swallowing due to irritation)
- esophageal motility changes: disrupted peristalsis and bolus transit
- statis of bolus in esophagus = risk of backflow
A mucosal band extending from the posterior pharyngeal wall anteriorly to the glottis.
Pharyngeal Web
- structural difference that can disrupt normal physiology of swallowing mechanism (globus sensation, pharyngeal residue, progressive solid food dysphagia)
What are Cervical Osteophytes and how do they cause dysphagia?
Bone growths on the cervical spine press against the posterior laryngeal wall
- disrupt normal swallowing sequence (laryngeal and/or esophageal level)
A white blood cell build up in the esophagus.
Esophageal Eosinophilia
- like an allergic reaction: inflammation (narrowing), can lead to scar tissue
- food can get stuck
What is Anterior Cervical Discectomy and Fusion and how does it cause dysphagia?
iatrogenic from surgery (ACDF)
removal of cervical disc from the neck with displacement of larynx and mechanical obstruction to esophageal and pharyngeal structures
- globus sensation, voice changes (wet, gurgly), coughing/choking during meals
What is Inclusion Body Myositis and how does it cause dysphagia?
- inflammatory degenerative muscle disease causing gradual and painless weakening of the muscles (poor lip seal, slow mastication, inadequate bolus cohesion, slow oral prep/transport)
- UES shrinks, globus sensation, danger of penetration/aspiration
How does Alzheimer's Disease cause dysphagia?
progressive neurodegenerative disease
- early: longer mealtimes, forget to chew/swallow, food pocketing
- middle: difficulty coordinating chewing/swallowing, delayed swallow initiation
- late: aspiration pneumonia, weight loss, malnutrition, need for modified diets/alternative feeding
What is Scleroderma and how does it cause dysphagia?
- autoimmune connective tissue disorder attacking body tissues resulting in excess collagen that hardens skin/organs
- oral: skin tightens, hard to open mouth (oral care), damage to salivary glands (dry mouth); peristalsis (esophageal muscles thicken and harden - slowed transport / globus sensation) and LES weakens (acid reflux)
A pouch that forms at top of the esophagus that makes it difficult to swallow.
Zenker's Diverticulum
- presents with difficulty swallowing, bad breath, chronic cough, globus sensation, regurgitation of food hours after eating, weight loss