Aspiration (Logemann, fig 3-11 to 3-14)
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.
may occur under several circumstances
- Before the swallowing reflex is triggered,
when the airway has not elevated or closed. It may result
- 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.
- 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
- 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
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
- 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
- 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
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
- 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.