Modified Mondays: Normalizing the Swallow - Premature (?) Spillage - How Low is Too Low?

One term I really really wish would just go away in swallowing assessment is “premature spillage”. We toss around it around during instrumentation all the time.. but what does it really say? Is it good data to gather? What does it even mean? The very term itself implies that it is something that shouldn’t be happening, but is it really a problem?

When we look at the research, it is clear that there is a wide variability in where it is normal for a bolus to accumulate prior to being swallowed. Even back in 1989 our field was seeing work that suggested this. The bolus location prior to swallow can also vary by volume, viscosity, and age… even within the same person. A great example can be seen in this video clip.

This is one of our Ohio MBS SLPs, healthy and normal, mid 30’s. Watch the first swallow of thin, in which the bolus accumulates in the pyriforms, and then the second, as the sold bolus accumulates in the valleculae. This variation of normal is completely common and needs to be considered before we call out a patient as impaired and “at risk” simply because the head of the bolus dares to dip below the ramus before the swallow is initiated.

https://pubmed.ncbi.nlm.nih.gov/16633870/

1989 study: https://link.springer.com/article/10.1007/BF02408037

https://pubs.asha.org/doi/10.1044/2019_JSLHR-19-00169