Aspiration - thin liquids

• The subject is presented with a small amount of liquid barium.
• During the oral stage of the swallow, please observe the limited control with barium falling over the base of the tongue, without a pharyngeal swallow being triggered.
• Because material falls over the base of the tongue, a small amount of liquid barium is aspirated before the pharyngeal swallow is triggered. The patient did demonstrate a cough reflex following the aspiration indicating good sensation.

Delayed Pharyngeal Swallow and Pharyngeal Pooling (movie "Adult delayed swallow")

• The subject is presented with a small amount of thickened barium.
• The same difficulty of poor bolus control can be seen with this material.
• During this study, the material is not controlled and slides or trickles into the pharynx. Triggering of the pharyngeal response differs based on the age of the individual. For those over 60, the pharyngeal swallow is not triggered until the bolus head reaches approximately the middle of the tongue base. This video segment ends when the bolus reaches this point.
• The amount of delay can be measured by timing the point at which the bolus head reached the middle of the tongue base until the pharyngeal swallow is triggered. In this example, there is a delay of approximately 2 seconds, which would be considered a mild delay. Because of the increased viscosity of the bolus, material pools in the valleculae prior to the initiation of the pharyngeal swallow and no aspiration occurs.

Once the pharyngeal response is triggered, good laryngeal elevation is seen. Following the swallow, there is significant pooling in the valleculae and pyriform sinuses, indicating reduced pharyngeal sensation. The subject did not spontaneously swallow a second time and had significant difficulty swallowing a second time when asked to do so.

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Special thanks to St.Mary's/Duluth Clinic (SMDC) Radiology and Speech Pathology departments for providing the videofluroscopy studies of the normal adult.