Penetration and Aspiration in Healthy Older Adults as Assessed during Endoscopic Evaluation of Swallowing

Abstract

Objectives: A previous article from our group presented data on normal swallowing as assessed during simultaneous manometry and flexible endoscopic evaluation of swallowing (FEES). Because penetration and aspiration events were identified in healthy adults, the question arose, could the presence of the manometric catheter confound normal FEES findings? Thus, a follow-up study was designed to address the effects of catheter condition on healthy older adults as assessed during FEES. Methods: Twenty older adults (mean, 78.9 years of age) participated. The participants each contributed 28 swallows, affording a study total of 560 swallows for analyses. Results: The older adults demonstrated penetration on 82 (15%) and aspiration on 18 (3%) of 545 swallows. The numbers of participants who had penetration and aspiration during the study protocol were 75% and 30%, respectively. The older adults demonstrated both penetration and aspiration events irrespective of the presence of a catheter; whether they were drinking milk, water, or barium; whether the bolus was 5 or 10 mL; and whether they took the bolus via syringe or self-administered the bolus with a cup. However, significantly more aspiration was found on thin liquids than on puree or solids. Conclusions: Endoscopic data on normal swallowing physiology were generated. These may serve as an accurate benchmark for clinicians and researchers in the interpretation of dysphagia.