A skilled nursing facility patient has a weak cricopharyngeus, causing difficulty passing the bolus through the cricopharyngeus muscle and past the 7th cervical vertebra. This most likely indicates disorders of which swallowing phase?

A skilled nursing facility patient has a weak cricopharyngeus, causing difficulty passing the bolus through the cricopharyngeus muscle and past the 7th cervical vertebra. This most likely indicates disorders of which swallowing phase?

• A. Esophageal Phase
• B. Pharyngeal Phase
• C. Oral Phase
• D. Laryngeal Phase

Answer: (A)

The essential idea is that the cricopharyngeus forms the upper esophageal sphincter, which must open for the bolus to move from the pharynx into the esophagus. During a normal swallow, the pharyngeal stage propels the bolus to the level of this sphincter, and the cricopharyngeus relaxes to allow entry into the cervical esophagus. If this muscle is weak, it doesn’t open adequately, so the bolus has trouble passing through into the esophagus and progressing past the start of the esophageal segment (around the level of the 7th cervical vertebra). That makes the issue a problem at the esophageal phase of swallowing, not the earlier oral or pharyngeal phases. The laryngeal mechanism is involved in airway protection during the pharyngeal phase, but the specific difficulty described here—passing through the cricopharyngeus into the esophagus—points to the esophageal phase.

The essential idea is that the cricopharyngeus forms the upper esophageal sphincter, which must open for the bolus to move from the pharynx into the esophagus. During a normal swallow, the pharyngeal stage propels the bolus to the level of this sphincter, and the cricopharyngeus relaxes to allow entry into the cervical esophagus. If this muscle is weak, it doesn’t open adequately, so the bolus has trouble passing through into the esophagus and progressing past the start of the esophageal segment (around the level of the 7th cervical vertebra). That makes the issue a problem at the esophageal phase of swallowing, not the earlier oral or pharyngeal phases. The laryngeal mechanism is involved in airway protection during the pharyngeal phase, but the specific difficulty described here—passing through the cricopharyngeus into the esophagus—points to the esophageal phase.