Objective: To assess the incidence of tracheal aspiration in the brain injury patients with laryngeal penetration, and to investigate the relationship between the type of laryngeal penetration and the severity of tracheal aspiration.

Method: One hundred videofluoroscopic swallowing tests in brain injury patients who showed laryngeal penetration were analyzed retrospectively. Laryngeal penetrations were classified into three groups: anterior, posterior and both. The incidence of the tracheal aspiration among the laryngeal penetration was evaluated. The severity of the tracheal aspiration was analyzed into the three groups: mild, moderate and severe. Each type of the laryngeal penetration were compared with the severity of the tracheal aspiration.

Results: Seventy-one patients showed the tracheal aspiration among the 100 patients with laryngeal penetration. The incidence of tracheal aspiration according to the type of the laryngeal penetration was 100% in both, 86.8% in posterior, and 50.9% in anterior type. The more severe tracheal aspiration was associated with the higher proportion of the posterior and both types.

Conclusion: The incidence of tracheal aspiration in laryngeal penetration was 71%. More severe tracheal aspiration occurred with both & posterior laryngeal penetration than anterior type.

Objective: The purpose of this study is to find the proper feeding posture for the safe liquid meal in the patients with neurogenic dysphagia.

Method: Fifty patients of neurogenic dysphagia with tracheal aspiration diagnosed with the videofluoroscopic swallowing test (VFST) were evaluated. VFST using 5 cc of barium solution was done for each patient in the sitting and supine position. The results of VFST of supine position were analyzed and compared with those of sitting position for the tracheal aspiration, laryngeal penetration, premature leakage, and laryngeal spillage.

Results: The incidence of premature leakage, tracheal aspiration, and laryngeal penetration is significantly decreased in the supine position (56%, 14% and 46%) compared to the sitting position (96%, 100% and 100%) (p＜0.001). The incidence of laryngeal penetration referable to the swallowing reflex is significantly decreased in the supine position (0%, 46%, 0%) compared to the sitting position (14%, 96%, 44%) (p＜0.001). The incidence of nasal regurgitation is 2% in the sitting position and 30% in the supine position.

Conclusion: The incidence of tracheal aspiration of liquid diet is significantly decreased in the supine position compared to the sitting position. The supine position would be safer than the sitting position in the feeding of liquid diet.

Method: Thirty patients who complained of swallowing difficulty or had potential for dysphagia were evaluated using videofluoroscopy and bedside swallowing evaluation for dysphagia. The bedside swallowing evaluations included gag reflex, laryngeal elevation, water swallowing test and swallowing provocation test. We compared bedside swallowing evaluations with videofluoroscopy to determine the sensitivity and specificity in detecting tracheal aspiration.

Results: The comparison of the all combination of bedside swallowing evaluation and videofluoroscopic results suggested that the sensitivity and specificity in the detection of tracheal aspiration was 84.6%, 47.0% respectively.

Conclusion: Bedside swallowing evaluations are limited for screening test of tracheal aspiration, so videofluoroscopic swallowing studies would be necessary to evaluate swallowing difficulty. (J Korean Acad Rehab Med 2003; 27: 489-493)