Comparison of timing abnormalities leading to penetration versus aspiration during the oropharyngeal swallow

Objectives/Hypothesis Penetration and aspiration during the oropharyngeal swallow have different clinical implications. This study examined temporal measures made from modified barium swallow examinations that might differentiate the two events. Study Design Retrospective cohort study. Methods Temporal measures of swallows of male patients with penetration only on the modified barium swallow study, those who showed aspiration (during the swallow), and normal control subjects were compared. Results Significantly longer durations of temporal measures (glossopalatal junction opening until laryngeal vestibule closure and laryngeal lifting onset until laryngeal vestibule closure) were found for the penetration and aspiration groups compared to the normal group. No significant differences were found between the penetration and aspiration groups for any temporal measure. Conclusions Both aspiration and penetration cases showed abnormal timing measures compared to normal. However, aspiration during the swallow was not associated with a more extreme abnormality of temporal measures than penetration. Therefore, in the aspiration cases, there may be an additional neuromuscular disorder at the vocal fold level, allowing for deeper invasion of material into the airway. In addition, findings point to slow laryngeal elevation, and not a delayed onset of laryngeal elevation, as the dominant cause for the prolonged intervals seen with aspiration during the swallow. Level of Evidence 3b. Laryngoscope, 124:935-941, 2014