Slikklachten bij stempatiënten

Demmink-Geertman, E.G. & G.T. Wassenaar-Postema (1985). Slikklachten bij stempatiënten. Logopedie en Foniatrie, nr 9, p. 232-235.
(Article in Dutch)

Voice problems and swallowing complaints
Hypertonia of hyoid muscles hampers the resting position and movement of larynx, hyoid and tongue. (For instance, at least seven muscles are active in this area to stabilize the position of the hyoid bone).

In this case dystonia of the muscles of palate, pharynx, cheeks, lips and chin is often symptomatic. The throat muscles are in the first place involved in respiration, mastication and swallowing and secondary in articulation and phonation. So it is obvious that an imbalance in this area can primarily stimulate disorders such as globus sensa­tion, aspira­tion, reflux, heartburn and temporo­man­dibu­lar joint dysfunc­ti­on, and only secondary articulation and voice problems.

Massage of palate, lips, cheeks, chin, region of the temporomandi­bular joint, cheek-bones and the m. temporalis (mastication) are executed by the therapist.

Next follows practise of yawning with accent on a nice downward and upward movement of larynx and hyoid and complete diaphragmatic respiration Aim of this exercise is obtaining optimal mobility of larynx and hyoid in up- and downward direction. With yawning the larynx reaches its lowest position. Optimal yawning movement is very comforting as it accompanies a deep diaphragmatically inspiration, followed by long expiration. A lot of air now enters the lungs.

In case of raised rest position of larynx and hyoid and the ongoing proposition of the tongue, it is possible that the mandible is shoved a bit in anteri­or direction. This leads to articulation dysfuncti­ons as sigmatismus interdentalis and to a restriction of the resonance spaces. Also the jaw movements are not performed in the right way and can evoke TMD. Therefore, control and eventually correction of the biting habits for substantial food (such as a cookie) will be necessary.

Also practising the swallow movement with emphasis on the little expiration after the swallow is done. At the end of the masticatory phase the larynx is raised and moves under the tongue base in order to protect the airway. This is the onset for the swallow. The lips are closed and the tongue will be elevated from anterior to posterior to trans­port the bolus through the oral cave. The fact that the posterior part of the tongue is tou­ching the soft palate triggers the palate to close the nasop­ha­rynx in a reflex. Then the bolus is transported through the pharyngeal cave by the contraction of the mm pharyngii con­strictor and will reach the oesophagus via the opening of the upper sphincter. The swallow ends with a little expiration. This expiration stimulates the descent of larynx and hyoid to their normal low rest position.

This little expiration is often omitted, which can cause not only symptoms of globus, but will also reduce the resonance spaces and so influence the phonation function.

Control and eventually correction of the method of drinking fluids is the next step of the therapy. Correctly taking a sip means pulling the upper lip, touching the liquid by the inside of the upper lip in order to control its temperature, correctly closing, transporting the liquid to the oral cave in posterior way, and swallowing.