Everyone can swallow, right? Even babies. Wrong. It turns out swallowing is an intricate, difficult series of very small actions that depend on the tongue, the , the , and the . It’s a combination of reflexive muscular actions. I have a dear friend who has been in the hospital for two months for something totally different, but one of the gating factors for him to get out is his ability to swallow. It seems that during his illness, he lost it.
Swallowing is a lot more complicated than you think, and if your body gets weak over all, the complicated muscular handoff that constitues the ability to swallow can leave you. Not only can long illness without food through the mouth create a problem, but so can many other things; injury, stroke, Bell’s Palsy, Alzheimer’s disease, and even just aging.
To swallow, you have to get your tongue to mix your food with saliva, and then guide it into the back of your throat to the pharynx. Once your tongue has done its job, things get really complex. The soft palate must rise to prevent the food from entering the back of the nasal passages.
The upper pharynx contracts, pushing the food down, while the voice box is pulled upwards by muscles in the neck. That bends the epiglottis downwards, creating a little slide that closes off the opening to the trachea and the larynx so food doesn’t go down the . The pharynx has to keep working, propelling the food along.
Here, another ring of muscles at the top of the esophagus then relaxes, allowing the wave of contractions to push the food into the esophagus. When there is no swallowing going on the muscles of that ring stay contracted so no food comes back up.
One common thing that can go wrong here is that the esophageal muscles can grow lazy or weak, and then your food comes back up into the pharynx. This is hearburn, or GERD.
When you swallow correctly, which is actually two microswallows, the food goes from the upper esophagus to the bottom, where another ring of muscles releaxes and the food can go into the stomach.
Very mechanical. When you eat a meal, your body functions like a little engine pushing the fuel along. All the belts and pulleys have to be tight or loose when they’re supposed to be.
So what happens if this fails? Well, then you get a speech therapist who comes in to strengthen each one of those muscle groups by giving you exercises. I actually watched those exercises one day last week, and that’s how I found my new respect for our ability to swallow, and how complex and finely tuned our brains and bodies are sending all these messages to all these little muscles that silently do their jobs (uless you eat carelessly or don’t chew your food, in which case you start to choke and cough).
The first exercises involve getting the lips stronger, which includes using a straw with your lips. Then you do tongue and lip coordination exercises, which make the tongue to strengthen itself and push the food backward, so you open your mouth and touch your top teeth with your tongue. Then you try to open your mouth and push your tongue to the back of your mouth. Next, combine movements, moving the tongue from the front to the back of the mouth. I’ve tried this; it’s harder than you think.
After that, you open your mouth and make a high pitched sound to strengthen your soft palate. And you make the sounds of letters that take place at the back of your throat. Then you say “ahhhh” and a high-pitched “eeeee.” It turns out “ahh” is a very important sound because it gets the vocal folds going and the pharynx moving up, which stop food from moving into the airways.
And guess what? Singing helps, too. Especially since you probably use certain consonants that are said by the back of the throat, like “g” and “k” sounds.
I have new respect for speech therapists, who I previously thought were most useful for lisping and stuttering. Not so. The girl I saw at the hospital had an amazing repertoire of exercises in her arsenal.