SLP Swallowing & Dysphagia Management 3 — Questions and Answers
Question 1: Which muscle is the PRIMARY contributor to upper esophageal sphincter (UES) opening during swallowing?
- Thyropharyngeus
- Cricopharyngeus
- Geniohyoid (Correct answer)
- Inferior pharyngeal constrictor
Correct answer: Geniohyoid
The geniohyoid, along with other suprahyoid muscles, pulls the hyolaryngeal complex anterosuperiorly, mechanically opening the cricopharyngeus/UES.
Question 2: A patient demonstrates 'premature spillage' of the bolus into the pharynx before the swallow trigger. Which oral stage impairment BEST explains this finding?
- Reduced labial seal
- Reduced tongue base retraction
- Impaired lingual control of the posterior oral seal (Correct answer)
- Reduced buccal tension
Correct answer: Impaired lingual control of the posterior oral seal
Premature spillage occurs when the posterior tongue fails to maintain a seal against the soft palate, allowing the bolus to enter the pharynx prematurely before pharyngeal swallow is triggered.
Question 3: When performing a FEES examination, which of the following BEST indicates laryngeal penetration rather than aspiration?
- Material is seen passing below the true vocal folds
- Material pools in the vallecular space bilaterally
- Material is visualized on the laryngeal surface of the epiglottis or in the laryngeal vestibule above the vocal folds (Correct answer)
- Material coats the posterior pharyngeal wall
Correct answer: Material is visualized on the laryngeal surface of the epiglottis or in the laryngeal vestibule above the vocal folds
Penetration is defined as material entering the laryngeal vestibule above the level of the true vocal folds, whereas aspiration requires material to pass below the vocal folds.
Question 4: The Mendelsohn maneuver is designed to improve swallowing safety and efficiency primarily by:
- Increasing tongue base retraction to clear valleculae
- Prolonging hyolaryngeal elevation to extend UES opening duration (Correct answer)
- Strengthening labial closure to prevent anterior spillage
- Reducing nasopharyngeal reflux by improving velopharyngeal closure
Correct answer: Prolonging hyolaryngeal elevation to extend UES opening duration
The Mendelsohn maneuver teaches the patient to voluntarily sustain peak hyolaryngeal elevation, thereby prolonging UES opening and improving bolus clearance through the pharyngoesophageal segment.
Question 5: A 55-year-old patient post-total laryngectomy is being evaluated for tracheoesophageal puncture (TEP) voice and swallowing. Which swallowing concern is SPECIFIC to total laryngectomy patients?
- Aspiration pneumonia due to loss of the cough reflex
- Pharyngoesophageal (PE) segment spasm causing difficulty with esophageal insufflation and swallowing (Correct answer)
- Impaired oral transit due to tongue resection
- Silent aspiration due to absent laryngeal sensation
Correct answer: Pharyngoesophageal (PE) segment spasm causing difficulty with esophageal insufflation and swallowing
After total laryngectomy, the PE segment (reconstructed from pharyngeal constrictors) may be hypertonic or spasmic, causing dysphagia and restricting voice prosthesis use — aspiration is not possible since the airway is separated.
Question 6: Which IDDSI food texture level is described as 'soft, tender, moist, and easily mashed with the tongue against the palate without chewing'?
- IDDSI Level 4 (Pureed)
- IDDSI Level 5 (Minced & Moist)
- IDDSI Level 6 (Soft & Bite-Sized) (Correct answer)
- IDDSI Level 7 (Regular)
Correct answer: IDDSI Level 6 (Soft & Bite-Sized)
IDDSI Level 6 (Soft & Bite-Sized) describes foods that are soft and tender enough to be mashed with the tongue, requiring minimal or no chewing.
Question 7: A clinician observes 'coating' of the posterior pharyngeal wall with barium after swallowing on MBSS. This finding is MOST consistent with:
- Reduced hyolaryngeal excursion
- Reduced pharyngeal constrictor strength (Correct answer)
- Impaired epiglottic inversion
- UES dysfunction
Correct answer: Reduced pharyngeal constrictor strength
Pharyngeal wall coating or residue on the posterior pharyngeal wall after swallowing indicates reduced peristaltic stripping by the pharyngeal constrictor muscles.
SLP Swallowing & Dysphagia Management 3
Which muscle is the PRIMARY contributor to upper esophageal sphincter (UES) opening during swallowing?