Observations Indicating Impaired Swallowing

• Drooling or loss of food from the mouth—due to impaired lip closure (impaired anterior containment)
  
  
• Collection of material in the anterior and lateral sulci during mastication—due to reduced tone in cheek musculature
  
  
• Reduced range of movement in lower jaw
  
  
• Reduced range, shaping, or coordination of tongue movements
  
  
• Premature escape of material from the mouth into the pharynx—due to impaired forward motion of the soft palate or impaired elevation of the back of the tongue
  
  

• Break-up of the bolus or its irregular propulsion from the front of the mouth backward to the pharynx—due to impaired ability of the tongue to elevate and make complete contact with the palate or to form a sequential wave from front to back against the palate in order to strip the bolus completely and smoothly towards the pharynx (impaired posterior containment)
  
  

• Loss of the bolus over the back of the tongue into the pharynx where it may collect in the open valleculae, pyriform sinuses, or airway—due to delayed triggering of the neuromuscular sequence in the pharynx which permits the bolus to enter the pharynx before the pharyngeal phase has been activated
  
  
• Reflux into the nose—due to reduced soft-palate closure
  
  
• Pooling of material in the pharynx, valleculae, and/or pyriform sinuses after the swallow—due to weak pharyngeal peristalsis by the pharyngeal constrictor muscles
  
  
• Passage of the bolus down only one side of the pharynx—due either to a mass on the contralateral side or to paralysis of the ipsilateral side
  
  
• Slow, reduced, or absent elevation of the larynx (watch the hyoid bone)
  
  
• Failure of the epiglottis to fold over the opening to the airway
  
  
• Aspiration of barium into the subglottic trachea—due to failure of the vocal cords to fully adduct during swallowing
  
  
• Delayed opening, incomplete opening, or premature closure of the UES—due to cricopharyngeus muscle dysfunction