Page 86 - Portuguese Journal - SPORL - Vol 61. Nº2

strength are valuable independent indices for of the pharyngeal muscles and reduction in
the diagnosis of sarcopenic dysphagia. Other pharyngeal pressure.
authors 10,11 have stated that the reduction Molfenter, Lenell, et al. reported an increase
in oral ejection strength and atrophy of the in the pharyngeal volume with age, which,
geniohyoid muscle are significantly associated along with atrophy of the pharyngeal
with aspiration in healthy older individuals. In muscles, decreases hyolaryngeal elevation.
addition to the decreased tongue strength, Furthermore, reduced UES opening may be
there is a reduction in the strength of the responsible for the presence of food residues
masticatory muscles (Table 1) . after swallowing at the level of the valleculae
12
and pyriform sinuses (Table 1) .
15
Pharyngeal Phase
The pharyngeal response can also become Esophageal Phase
slower with age, although this parameter Age-related changes have also been
was not significantly different between older described in the esophageal phase, such as an
people and young adults 13 . Martin-Harris increase in the duration and reduction in the
et al. used a validated tool for assessing esophageal peristaltic amplitude. In healthy
swallowing and concluded that the most older adults aged over 80 years, esophageal
affected parameters in this age group were muscle weakness leads to the dysfunction of
anterior excursion of the hyoid, pharyngeal esophageal peristalsis and gastroesophageal
contraction, UES opening, and retraction of reflux disease, predisposing these individuals
the base of the tongue . to the risk of reflux-related aspiration (Table 1) .
14
16
Other factors that put healthy older
individuals at risk of aspiration are atrophy The natural aging process leads to changes

Table 1
Changes in the swallowing phases in older people 12-17

Oral Phase
Changes Consequences
- Loss of dental pieces/dental prosthesis maladjustment - Difficulty in bolus preparation and its
- Reduced production of saliva propulsion to the pharynx
- Change in the oropharyngeal flora
- Changes in taste and smell
- Decreased strength of the masticatory muscles
- Reduced tongue pressure and mobility
- Reduced mandibular and maxillary bone tissue
Pharyngeal Phase
Changes Consequences
- Delay in the onset of the swallowing reflex - Increased duration of the pharyngeal phase
- Decreased tonus of the pharyngeal and - Reduced elevation of the hyoid
suprahyoid muscles - Retention in the valleculae and pyriform
- Decreased pharyngeal sensitivity sinuses
- Delayed movement of the epiglottis
- Delayed opening of the UES
Esophageal Phase
Changes Consequences
- Dysfunction of the upper esophageal sphincter - Bolus retention in the upper esophagus
- Decreased esophageal peristalsis - Esophagitis
- Esophageal dilatation - Laryngopharyngeal reflux
- Dysfunction of the LES

228 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery