Monthly Archives: January 2018

Dysphagia – Episode 113

 in Podcasts  tagged age / aspiration / babies / choking / coughing / difficulty / drink / dysphagia / esophageal / food / kids / oral / pharyngeal / phases / pneumonia / risk / swallowing / therapy by

An image of a striped snake with black top scales and yellow underbelly scales slithering through sand. The snake has had no difficulty swallowing a rather large animal that has stretched out the rounded body behind the head with the last bit of the animals feet sticking out of the snake's mouth.

Dysphagia Basics

Having difficulty swallowing or the inability to swallow is known as dysphagia.

Symptoms of dysphagia include:

  • Pain while swallowing
  • The sensation of food stuck in the throat or chest
  • Drooling
  • Hoarseness
  • Regurgitation
  • Reflux
  • Unexpected weight loss
  • Choking, coughing, or gagging when swallowing
  • Taking tiny bites

Dysphagia by Phase

There are several conditions that can affect each phase of the swallowing process.

Oral Phase

Dysphagia during the oral phase, or voluntary phase, can be caused by neurological conditions like Multiple Sclerosis, Muscular Dystrophy, advanced Parkinson’s.  Brain damage caused by trauma or stroke can also cause trouble swallowing in adults.

Dysphagia in Kids

Babies start out nursing or feeding through a bottle and their swallowing mechanism is reversed.  A reverse swallow is when the tongue is thrust forward or out of the mouth to open the throat and allow food or drink down the esophagus.  As children learn to eat solid food and drink from a cup, the swallowing procedure changes. Children can also have trouble swallowing, but the root causes are completely different.  Premature birth, low birth weight, cleft lip or palate, and tongue or lip ties can lead to swallowing issues if not corrected with therapy.  These issues can cause swallowing issues with the reverse mechanism as well as make it difficult to convert to a regular swallow.  Children with low muscle tone are also more likely to stick with the reverse swallow because it is easier.

Pharyngeal Phase

Pharyngeal diverticula are pouches that form in the mucous membrane above the esophagus.  These pouches can collect food particles that don’t get swallowed.  This can cause bad breath, as well as coughing, and constant throat-clearing because it feels like something is stuck in the throat.

Esophageal Phase

There are several swallowing issues that stem from the esophagus and esophageal phase.

  • Achalasia is an issue where the sphincter that opens into the stomach doesn’t relax to allow food to pass through.  This can cause pressure in the chest and may possibly lead to regurgitation if it persists.
  • Diffuse spasms happen when the peristalsis rhythm of the esophagus muscles is poorly coordinated.
  • Stricture is also known as a narrowed esophagus.  It can be a result of injury and scarring from GERD.
  • An esophageal ring is when a thin area of the lower esophagus is narrowed.  This is also a result of scar tissue from chronic GERD.  The scar tissue from acid damage tends to be less flexible which can cause pain.
  • Eosinophilic esophagitis is the overpopulation of eosinophils in the esophageal lining due to food allergies.  Eosinophils are a type of white blood cells that show up in very specific situations – parasitic infections, cancer, or allergies.

Dysphagia Risk

The risk of dysphagia increases with age, mostly because the risk of the conditions that cause dysphagia increases with age as well.  And while dysphagia can be very uncomfortable, the biggest concern is with the risk of aspiration, or breathing food or drink into the lungs, that leads to pneumonia.

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Swallowing
Muscle Tone discussion – Accordion in Your Brain

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Swallowing – Episode 112

 in Podcasts  tagged dentist / esophagus / food / mouth / reflex / saliva / Sleep / swallowing / teeth / throat / tongue by

 

A young child with no shirt and light brown hair against a blue sky is swallowing gulps of orange juice from a clear plastic bottle.

The 3 Phases of Swallowing

Oral Phase

This phase includes chewing and saliva mixing with the food to form a bolus (a little glob of mashed up food). Then the tongue moves the bolus towards the back of the mouth.  The tongue starts by pressing against the hard palate behind the front teeth.  Then the sides of the tongue raise up to also press against the hard palate inside the teeth.  At this point, the bolus has nowhere to go except towards the back of the throat.

Pharyngeal Phase

The vocal folds in the larynx close to keep food out. The larynx also moves up as the epiglottis covers it to seal off the airway. Then the soft palate and uvula move up and close off the nasal passage  So now there is only one way out.

Esophageal Phase

The bolus moves into the esophagus (because it is the only open path). The esophageal muscles contract from top to bottom (this waving, rhythmic muscle movement is called peristalsis) to push the bolus into the stomach.

Swallowing Reflex

There are sensory receptors in the pharynx and tongue that receive touch signals.  When they are touched by a bolus, the signals are sent to the brain stem and the return signal results in involuntary and automatic movements of the larynx and epiglottis.  This is a good thing since swallowing is a very rhythmic process and you want food and drink to continue going in the correct direction.

This reflex cannot be triggered by sticking your finger in your throat.  You are more likely to trigger a gag reflex that way.  The voluntary steps of swallowing must be initiated before the involuntary portion of the process takes over.

Weird Swallowing Scenarios

How do you swallow with your mouth open?

At the dentist, you are usually laying in the chair on your back and facing the ceiling.  There are at least three tools and two hands in your mouth.  Things in your mouth trigger saliva production.  Also, generally one of the tools the dentist is using is emitting water.  The natural reflex when you have to hold your mouth open for a long time is to bring the back of the tongue and the soft palate together.  This seals off the throat and allows you to still breathe through your nose.  The liquid in your mouth plus gravity creates a puddle at the seal of your tongue and soft palate.  Because the touch sensors to trigger your swallowing reflex are also in this area, it is likely you begin to panic because if they don’t hurry and use the suctioning straw to remove the liquid, you’re going to swallow!

Do you swallow in your sleep?

A study was done to find that the only times you swallow while sleeping is during arousal and during REM.  My logical deduction regarding why is that when you’re aroused or in one of the more shallow phases of sleep, that is when you can voluntarily move – roll over, adjust the bedding, and swallow.  During REM sleep, most people will experience sleep paralysis, so whatever exciting things are happening in their brain, the body is not likely to act it out.  Because the brain cannot tell if a dream is real or imaginary, the feeling solicited can trigger hormones secretions and saliva production. Increased saliva, just like in the dentist scenario, can trigger swallowing.

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Tonsillectomy – Episode 111

 in Podcasts by

A close-up image of surgical tools laying on a tray covered in a teal colored cloth. From left to right, there is a scalpel, a pair of scissors, two pairs of tongs, a suturing tool, and a pair of tweezers. Many of these tools are used in the traditional surgical methods for a tonsillectomy.

What is a Tonsillectomy?

A Tonsillectomy is a surgical procedure to remove the tonsils.  Tonsil – immune system tissue in the back of the throat.  -Ectomy = to remove something from the body.

Removing the tonsils may be required if chronic tonsilitis is a problem.  Chronic tonsilitis is defined as multiple infections in a row or an infection lasting 3 months or longer.  Severe snoring and sleep apnea may be another reason to remove the tonsils, for the purpose of opening up the airway.

Adenoids

Adenoids are another set of immune system glands in the back of the nasal cavity.  They can also swell during infections and interfere with breathing.  Depending on the severity of the infections or the risk of sleep apnea, these may also be removed in the same or a similar procedure.

Tonsillectomy Methods

Since general anesthesia is used in all methods to remove the tonsils, no eating is allowed before the procedure.  They also recommend no NSAIDs (non-steroidal anti-inflammatory drugs) are to be used before and after due to their ability to thin the blood and increase the risk of bleeding.  In general, a tonsillectomy will take between 30 and 60 minutes.  Recovery time afterward is estimated to be about two weeks.

  1. Scalpel
    This is the old school method of using a very sharp surgical knife to cut out the tonsil.  This method has the highest risk of bleeding.
  2. Cauterization
    This method involves a hot knife that separates the tonsil tissue from the throat.  The heat also closes off the blood vessels so bleeding is not as severe.  A downside is that the tissue has been burned, so I imagine the pain after this method is more severe.
  3. Ultrasonic Vibration
    Ultrasonic waves are sound waves that have a higher frequency than the human ear hears.  The waves cause a very rapid vibration and the energy of those waves is what causes the tissue to separate as well as the blood vessels to clot.  This is the newest method developed and seems to have the least bleeding and pain.

After the Tonsillectomy

The side effects of a tonsillectomy include swelling of the throat, as well as the face and jaw, bleeding, and infection.  To avoid the bleeding and infection, it is important to follow all the instructions given for the recovery period.  Because of the swelling, cold foods like ice cream and popsicles are popular because cold things reduce swelling.  Popsicles can also help with hydration because swallowing bigger sips or gulps of water can be painful the first few days.  Hot foods are not recommended because the heat can increase the pain or reinjure the surgical site.  And while ice cream is the most popular post-tonsillectomy food, any soft, non-abrasive foods are fine to eat.

Why do adults have more issues than kids?

Kids heal faster because they are still growing and developing.  Kids also have smaller body parts than adults – the tonsils are smaller and the blood vessels are smaller.  Smaller blood vessels clot and heal faster than larger ones.  This is even true between the different sized blood vessels in your own body.  And a factor no one wants to admit: adults are terrible at following directions and truly resting after a surgery or procedure.  Rest is the best thing for a healing body of any age or size.

Strep Carriers

Generally, when we think of severe tonsilitis that leads to a tonsillectomy, we think of strep throat.  A carrier is someone who carries the germ around with them but does not get sick from the germ (pertussis is another example). In 1998, a study found that 5-15% of school-aged children were asymptomatic carriers of strep.  This means they tested positive on a strep swab but had no symptoms of being sick.  This causes concern because it means that you can be sick with something else that causes vague symptoms like fever and sore throat but because the strep test is positive, antibiotics are prescribed when they might not be necessary (meaning that you were sick from a virus).  This study showed that providers and caregivers were unaware of the number of unnecessary antibiotics they were prescribing.

Strep is eradicated from a carrier by an extensive treatment of antibiotics, or by removing the tonsils from the carrying family member as well as the tonsils of the chronically sick family member. #tonsillectomyforeveryone

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851340/

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Facebook Memory: Episode 74
Sleep Hygiene
All About Sleep

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