Modified Monday: The Value of Aspirations

Hoping by now we all know that aspiration isn’t always as important as we maybe used to think it is…however, it’s still important to catch it and collect that information, and most importantly, figure out WHY it’s happening. This patient is great example of how the WHY is really critical in arriving at the best and most comprehensive plan of care.

On the second swallow in this clip, this patient aspirates VERY quickly. It is difficult to see, as it doesn’t “collect” together at the anterior commissure or the posterior. It’s lighter in appearance and just “drops” right in . This is highly characteristic of incomplete vocal fold closure, and sure enough, after the patient was turned to the A-P view, our SLP observed this and made the ENT referral. The patient has a history of laryngeal CA three years prior, so catching this and getting the consult was significant.

As you keep watching, you can also see penetration and subsequent aspiration happen both anteriorly and posteriorly. The posterior pyriform space appears a bit crowded (possibly edematous) , and incomplete airway closure and base of tongue retraction were noted during the swallow… all of which reinforces the need for the consult.

In instrumental assessment, we have a valuable tool with which to collect information about a patient. Making sure that we collect ALL the data AND know what to do with it is what makes US valuable as clinicians.