On 12 January 2026, Myotubular Trust hosted a ‘Supporting A Safe Swallow’ Webinar with leading experts Professor Katlyn McGrattan Speech-Language-Hearing Services at University of Minnesota and Professor Giovanni Baranello, Paediatric Neuromuscular Disorders at Great Ormond Street Hospital, London. We would like to thank them both for delivering such an informative presentation to help our patient community.

Summary

This webinar explored bulbar function – how swallowing works and how the body protects the airway while doing it. Professor McGrattan explained how breathing and swallowing share the same space in the throat, which means the body must coordinate these actions very carefully. She also talked about swallowing problems seen in neuromuscular conditions, especially issues with saliva and other secretions, difficulty opening the mouth, and challenges faced by people with conditions such as myotubular myopathy. Professor Baranello explained how to go about testing a swallow.

There were a number of parent Q&A’s during the session which can be read here Safe Swallow – Q&A – 20 January (PDF). If you wish to ask more, please contact Professor Katlyn McGrattan, using this Google Forms Link or the scan the QR Code.

How Swallowing Works and How the Airway Is Protected

Dr McGrattan explained that swallowing is a complex process because the same passage in the throat is used for both breathing and swallowing. The body must time everything perfectly so that food or drink doesn’t go “down the wrong way” into the lungs (aspiration).

Swallowing has two main jobs:

• Protecting the airway so nothing enters the lungs.
• Clearing the bolus, meaning moving food or liquid safely from the mouth to the oesophagus.

She described how the voice box (larynx) and the vocal folds close tightly during swallowing to block the airway. Although the epiglottis (the flap at the back of the tongue) helps, it is actually the upward and forward movement of the larynx that provides the strongest protection. She also noted that “perfect” swallowing is rare, even in healthy people, but understanding the process helps guide care for people with conditions like myotubular myopathy.

How the Body Moves Food and Liquid

Swallowing involves many muscles working together. The tongue pushes food or liquid backwards, and muscles in the throat squeeze to move it down into the oesophagus. All of these steps are linked, and if one part doesn’t work well, airway protection can be affected.

Swallowing Problems in Myotubular Myopathy

People with myotubular myopathy (MTM) or centronuclear myopathy (CNM) often have difficulty swallowing (dysphagia). They may rely on feeding tubes and struggle with sucking, chewing, and managing saliva or other secretions.

A major issue is that difficulty closing the airway can also make it harder to open it again. Some people have trouble clearing secretions because the upper oesophageal sphincter (the “door” to the oesophagus) doesn’t open well. When secretions sit in the throat for too long, the tissues can become less sensitive, reducing the natural urge to swallow. This increases the risk of aspiration and pneumonia.

Dr McGrattan stressed that aspiration is important to take seriously, but it usually has several contributing factors. It should not automatically be blamed on trying small tastes of food or even sterile water.

Therapies for Neuromuscular Swallowing Difficulties

Several strategies may help improve swallowing and secretion management in neuromuscular conditions:

• Vibration devices placed on the outside of the throat may help stimulate swallowing. Higher‑frequency devices (70–110 Hz) show some promise, but even simple vibration tools like the Ark Z‑Vibe may help trigger the swallow reflex.
• Changing the size or thickness of food or liquid can sometimes help the muscles work more effectively.
• Jaw‑stretching devices such as the Therabite may help people who have difficulty opening their mouth, which can affect eating, oral hygiene, and speech. These devices may help prevent or improve jaw tightness (contractures).

Tests Used to Assess Swallowing Problems

Dr McGrattan highlighted the importance of specialised tests to understand swallowing difficulties:

• VFSS (Video Fluoroscopic Swallow Study) uses X‑ray video to watch how someone swallows.
• FEES (Flexible Endoscopic Evaluation of Swallowing) uses a small camera through the nose to view the throat during swallowing.

These tests help identify specific problems and guide treatment, such as adjusting posture or changing food textures. She also mentioned manometry (measuring pressure in the throat and oesophagus), the use of barium during swallow studies, and the role of speech therapists in supporting communication and swallowing. She emphasised the need for teamwork across different healthcare professionals and regular monitoring.

Glossary of Medical Terms