Question
Please discuss/review the most common etiologies of swallowing disorders in adults.
Answer
Because the swallowing process can be divided into three phases: oral, pharyngeal and esophageal, the etiologies of swallowing disorders can be discussed in relation to these phases.
In the oral stage of the swallow, anything that affects tongue, lip, jaw and palatal function can cause disordered swallowing. Neurological disorders such as CVA, Parkinson's disease, ALS and other such disorders can affect the coordination of the oral musculature which can, in turn, affect swallowing. Structural abnormalities in this area such as cleft palate, dental malocclusion, poor dentition and surgical alteration of the oral cavity can also affect the oral stage of the swallow. In the oral stage, any of these disorders can cause difficulty chewing food and moving it to the back of the mouth to be swallowed.
Neurological disorders can also affect the pharyngeal phase of the swallow by causing swallow initation to be delayed and the bolus to be pooled in the pharynx. Neurological disorders and surgical alterations of the epiglottis and/or vocal folds can cause reduced airway protection and passage of the bolus into the larynx rather than the esophagus, resulting in aspiration.
In the esophageal phase, most swallowing disorders are due to reduced esophageal motility, esophageal obstruction or stricture, or GI reflux.
In summary, most swallowing disorders in adults are due to:1) neurological disorders such as CVA, Parkinson's disease, ALS and others 2) surgical alterations of the oral cavity, pharynx or larynx due to cancer and 3) motility and structural abnormalities in the esophagus.
Kathy Thayer received her Master of Arts in Health Services Management from Webster University and a Certificate in Gerontology and a Master of Arts in Communication Disorders from Saint Louis University. Kathy has worked for several years as a Speech-Language Pathologist and is currently employed by Rehab Works in Sparks, Maryland
