Which mechanisms may contribute to intubation-related swallowing impairment?

• A. Local tissue damage
• B. Edema
• C. Paresis
• D. All of the above

Answer: (D)

Intubation can affect swallowing through several mechanisms that alter both the structure and the neural control of the swallow. Local tissue damage from the endotracheal tube or cuff can injure the mucosa of the pharynx and larynx, leading to pain, altered sensation, and disrupted timing of the swallow. Edema from inflammation around the laryngeal and pharyngeal areas can cause swelling that narrows the airway and hampers hyolaryngeal movement and airway protection during swallowing, increasing the risk of post-extubation difficulties. Paresis or weakness may occur when nerves or neural pathways governing swallowing are stressed or compressed during intubation, reducing pharyngeal constriction, laryngeal closure, and hyolaryngeal elevation. Because each mechanism can occur on its own or in combination after intubation, all of these can contribute to swallowing impairment following intubation.