CSD 5200

Aspiration (Logemann, fig 3-11 to 3-14)

Aspiration is a generic term refering to the action of material penetrating the larynx and entering the airway below the true vocal folds. Purpose of swallowing evaluation is to define the reason for the presence of aspiration.

Aspiration may occur under several circumstances

• Before the swallowing reflex is triggered, when the airway has not elevated or closed. It may result from:
  • Reduced Tongue Control - If the tongue loses control of the bolus, part of the food may roll into the pharynx and into the airway before the reflexive swallow occurs. This food falling into the pharynx does not elicit a swallowing reflex because the tongue has not completed its movement to trigger the reflex. This is evidence that just the bolus does not elicit the swallow. This type of aspiration may occur more frequently on liquids and may be seen in neurologically impaired patients or in individuals who have undergone oral surgical procedures.
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  • Delayed or absent swallow reflex. If the swallowing reflex does not trigger on time, the food will usually roll into the pharynx by tongue action. With no reflex triggered, the airway is open and food may fall into the airway before the reflex triggers. Where the food falls will depend on the amount of food, the food consistency, and posture of the patient.
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  • Delayed triggering of the swallowing reflex is a common disorder following CVA accident, head trauma or surgical procedures affecting the tongue.
• During the swallowing if the laryngeal valves are not functioning adequately. It may result from reduced laryngeal closure (c10).
  • When the larynx is not closed tightly enough, food can penetrate into the trachea. The only cause for aspiration during the swallow is reduced laryngeal closure. During the swallow, the larynx closes at 3 levels: epiglottis and aryepiglottic folds, false vocal folds, and true vocal folds.
  • In order for aspiration to occur during the swallow, food must penetrate all 3 levels.
  • Aspiration during the swallow is not common in CVA patients and post head trauma patients. Most common with patients who have undergone partial laryngectomy, hemilaryngectomy or supraglottic laryngectomy.
• After the swallow when the larynx lowers and opens for inhalation. It may result from:
  • reduced peristalsis - residue remains in the valleculae or is equally distributed between the valleculae and pyriform sinuses.
  • reduced laryngeal elevation - When the larynx sits lower in the neck, a ledge is formed which catches part of the bolus. There is residue remaining at the top of the airway which is then inhaled.
  • unilateral pharyngeal damage (neurologic or structural) - residue remains in the valleculae and pyriform sinuses on the damaged side.
  • cricopharyngeal dysfunction.- there is residue in the pyriform sinuses with very little material left in any other part of the pharynx.
  • Esophageal or gastric disorder which causes reflux.
  • Aspiration after the swallow is seen frequently in neurologic populations and in patients with head and neck cancer.

Necessary to identify those defects in oral, pharyngeal, or laryngeal structure or function that cause the particular type of aspiration. Treatment is then directed at the cause of the problem, rather than at the result (the aspiration).

Videofluroscopic Study - Information from videofluoroscopic study used to:

• define anatomic and.or neuromuscular dysfunctions present in pt's swallow
• determine whether pt should be by mouth or not, and if so, the consistency of foods to be given.
• plan direct or indirect treatment appropriate for the specific swallowing disorders.

Penetration - is a generic term refering to the action of material penetrating the larynx and entering the airway above the true vocal folds.

• Prior to Swallow (c2)