Dysphagia 133the lungs. In this phase, the larynx elevates and moves anteriorly, and the epiglottis snaps down
to further protect the lungs. The tongue pistons the liquid or food mass posteriorly, and the third
phase is triggered: the laryngeal- esophageal phase. In this book, the final phase is called laryngeal-
esophageal rather than esophageal to emphasize the importance of the protective laryngeal actions
during the combined phases and to account for respiratory clearing actions such as throat clearing
and productive coughing.
Perlman and Christensen (1997) suggest the term pharyngealolaryngeal to include the
laryngeal activities. Table 7-1 shows the stage, function, nerve, muscle, and tissue for each phase
of the swallow.
Taking food into the mouth, creating a bolus, moving it to the back of the oral cavity, and
swallowing it are dynamic interconnected acts performed, for the most part, without conscious
thought. Also, conversational speech frequently occurs during meals and while chewing and
swallowing. Figure 7-1 shows bolus creation and movement through the oral, pharyngeal, and
laryngeal- esophageal phases.
Dysphagia Evaluation
There are two separate but related aspects to a swallowing evaluation: clinical/bedside
screening and instrumental assessment. Before either is completed, the patient’s medical and social
history is reviewed. This review includes a careful study of the patient’s chart and questioning
of the intake nurse or another informed party. Review of the patient’s medical history reveals
the admitting diagnosis. The admitting diagnosis and the report show whether the patient
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