Pharyngeal Stage

Question 0

What should be observed during the pharyngeal stage?

Answer 0

A quick laryngeal elevation with slightly lower descent

The extent of elevation

Tongue pumping which often occurs with laryngeal bobbing

Effort to initiate a swallow reflex

Possible delay in triggering the swallow: up to 3 seconds is considered safe where over 5 may indicate a higher likelihood of aspiration

Question 1

What should you ask about a patients cough?

Answer 1

What consistencies of food and/ or drink cause the problem?

When is the cough triggered:
Before swallow
During swallow
After swallow
Only after build up of residue in larynx (indicated by gurgly voice)
Only on food
Only on drink

The effectiveness of the cough:
Weak/strong cough
Throat clear - likely to take longer to clear
Ineffective cough

Question 2

What is indicated by a wet or gurgly voice?

Answer 2

Pooling of the bolus in the pyriform which has spilt over into the airway penetrating the vocal folds

Pooled material may be subsequently aspirated if the larynx is insensitive to it

Question 3

What is indicated by a breathy or hoarse voice?

Answer 3

Impairment of the vocal fold adduction

Unilateral and bilateral vocal fold weakness often occurs in conjunction with pharyngeal weakness, the latter potentially resulting in pooling and hence a wet voice

Question 4

What are the signs of a pharyngeal stage dysphagia?

Answer 4

Delayed or absent swallow reflex

Piece meal swallow - divide bolus up and swallow a piece at a time

Bolus passes back of tongue but reflex doesn’t trigger or is delayed

Wet voice

Coughing

Due to:
Impaired base of tongue movement
Impaired pharyngeal movement
Reduced laryngeal elevation