Swallowing and CMT

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Swallowing

By Bonnie Pfeiffer, MA, CCC-Sp.

Research in the area of swallowing problems specific to CMT is

limited, if any. There is, however, a great deal known about the

types of swallowing problems symptomatic of other degenerative

diseases similar to CMT. Tests are available to diagnose specific

impairments and techniques for compensation can be learnt.

Normal swallowing consists of three phases: oral, pharyngeal, and

esophageal.

During the oral phase of swallowing, food must be chewed, moved on to

the tongue, gathered together, pushed to the back of the mouth, and

squeezed into the throat by the tongue muscles. In the pharyngeal

phase, the sensation of food entering the throat sets in motion a

wave of muscle contractions that propels the food to the opening of

the esophagus (food pipe) where a circular muscle, or sphincter,

opens to allow passage through the esophagus into the stomach. Food

travels through the esophagus in much the same way as it does through

the throat – by a series of muscle contractions activated by sensory

input.

Degenerative neurological disease can create problems in the

swallowing system similar to those affecting other sensory/motor

functions elsewhere in the body: decreased sensory input, muscle

weakness or visible atrophy, and in coordination of movement.

Symptoms may occur such as difficulty in chewing or moving food

around with the tongue, inability to swallow (initiate he " swallowing

reflex " ), the sensation of food " getting stuck " in the throat or

esophagus, choking on liquids, or regurgitation of food into the

mouth or nose. Poor vocal cord closure, decreased laryngeal (voice

box) elevation, and insufficient or difficult breathing patterns can

also interfere with swallowing.

A series of tests, involving a number of different medical

specialists, can be used for swallowing evaluation. Because

swallowing is a dynamic process, a particularly useful method of

evaluation is a video-fluoroscopic study – also called a " cookie

swallow " or modified barium swallow. A videotaped recording, under

radiation, is made while the patient swallows different food

consistencies (liquids, pastes, or solids) of radio-opaque material –

usually barium. In most facilities this test is performed as a

cooperative procedure between a radiologist and a speech pathologist

or occupational therapist.

A number of additional medical tests may be recommended based on the

results of an initial video-fluoroscopic swallowing study. Referral

to an ENT (ear, nose and throat doctor) for an indirect laryngoscope

is warranted when there is concern about the ability of the larynx to

protect the airway during swallowing. The physician will look in the

throat with a special instrument to assess the ability to close the

vocal cords, elevate the voice box, and clear the airway of any

foreign substance by producing a strong cough.

A fiber-optic bronchoscope is of similar diagnostic value in looking

at the larynx with the increased capabilities provided by the use of

sophisticated photographic techniques. The upper airway is also

visualized for the presence of infection, bleeding, and tumors or

other obstructions that may be causing breathing difficulties or

otherwise interfering with swallowing.

Further assessment of the esophagus can be accomplished by doing an

endoscope (insertion, through the mouth, of an instrument capable of

allowing the physician to view the food pipe from the inside) or

manometry. Esophageal manometry is useful in diagnosing weak or

poorly coordinated muscle contraction and dysfunction of the muscle

that permits food to pass from the esophagus into the stomach.

Some people with CMT have swallowing difficulties; but not all show

the same degree or combination of symptoms. It is, therefore,

important to obtain a thorough evaluation of swallowing and its

related systems by medical professionals. The good news is that many

of these problems can be easily compensated for and assisted by

therapeutic techniques.

Most major medical facilities evaluate swallowing function by video-

fluoroscopy and selective additional testing. Contacting the

Departments of Speech Pathology (Communication Disorders) or

Occupational Therapy in area hospitals or rehabilitation centers may

be a good place to start for advice. Universities offering training

programs for rehabilitation professionals can also be of help. In the

United States, several regional swallowing centers are available for

direction and consultation services. The Consumer Division of the

American Speech Language and Hearing Association will be able to

provide information concerning services available in your area.

(Article courtesy of former CMT Intl)