Can We Ignore Laryngeal Penetration?

A recent retrospective study (DR Duncan et al. JPGN 2019; 68: 218-24) makes it clear that laryngeal penetration is an important finding when identified on a swallow study. The authors reviewed charts from 137 subjects (mean age 9 months) who had laryngeal penetration but not aspiration with a video swallow study (VSS).

Key findings:

  • 40% of patients with laryngeal penetration receiving thickening of feeds as treatment, 15% had a change in flow rate.  60% were maintained on thin liquids.
  • Thickening feeds was significantly associated with improvement in symptoms with OR 41.8.  91% of subjects with thickening had symptom improvement compared to 19% among group with no feeding intervention.
  • Subjects receiving a feeding intervention (thickening or change in flow rate) had decreased total  and pulmonary hospitalizations.  In contrast, in patients who did not have a feeding intervention, no significant decrease in hospitalization was noted. These data are tabulated in Table 3.  It is worth noting that those who had feeding intervention had higher risk of admission prior to feeding intervention, 0.69 compared to 0.53 for non-intervention group. Afterwards, the feeding intervention group  risk was  0.40 compared to 0.45 for the non-intervention group.
  • On followup VSS, 26% had evidence of aspiration.

One key point is that those with deep penetration were much more likely to have their feeds thickened/adjusted.

My take: This study makes it clear that all symptomatic children with laryngeal penetration should have adjustment in their feedings, most often thickening of their feeds.   These interventions appear to lower hospitalizations and are needed because in many cases the swallow dysfunction does not resolve or worsens.

Related blog posts:

Georgia Aquarium

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.