Modified Mondays: The epiglottis-a debate

Around our Cleveland office, there is a LOT of discussion about the epiglottis. (Unsurprisingly?) We have very healthy arguments about the relative importance and unimportance of this structure that a lot of SLPs are very VERY focused on. The epiglottis moves around a lot during the swallow and could even be seen as “flashy” if you think about swallowing wayyy too much-as we do. One such discussion around the epiglottis culminated with one of our SLPs Angela throwing out a “You just don’t like the epiglottis because yours is so small!!” – which is probably the most SLP insult EVER.

Some studies have looked at patients post-epiglottectomy (see reference below) and found that patient were able to swallow without the epiglottis. The movement of the epiglottis that everyone seems to get excited about is actually passive, and depends on laryngeal elevation, base of tongue retraction and the bolus itself. So while we might notice things like incomplete epiglottic deflection... the underlying impairment is what we should be documenting.

So when Angela called me (our Director of Clinical Services and Education – who also just happens to have a really small epiglottis) and told me she had a patient with no epiglottis… and decent airway protection, there MIGHT have been some expressions of feeling redeemed, validated, and even victorious directed toward Angela. This patient had the epiglottis removed due to a history of cancer, which was actually not noted in the patient history, and the patient didn’t mention it before the study. If you have the sound on, you will hear our SLP comment on the lack of epiglottis.

This patient does have some penetration and some trace aspiration eventually, but overall does well. It’s really important to note that a patient with no epiglottis is going to need good, timely airway closure and control, since the valleculae is absent-which is a first line protection for the airway.

And to be clear-we are not saying that the epiglottis is useless! Just that swallowing is complicated and involves more than just a flashy flapper that likes to steal the show.

Leder SB, Burrell MI, Van Daele DJ. Epiglottis is Not Essential for Successful Swallowing in Humans. Annals of Otology, Rhinology & Laryngology. 2010;119(12):795-798. doi:10.1177/000348941011901202