"Normal" Laryngeal Penetration

James L. Coyle (University of Pittsburgh) wrote on the Dysphagia List-Serve:

"Robbins et al. (1999) used the PA {Penetration/Aspiration} Scale to differentiate normal from abnormal airway protection, and was written by the same group of authors of the original Penetration Aspiration Scale paper (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996).

They found that all laryngeal penetration events in this group of 95 healthy subjects, showed penetration no more deeply than the laryngeal vestibule. All of these "penetration" events (55 events out of 284 swallows) were scored {as a} 2 (material enters the airway, remains above vocal folds, no contrast is visible in larynx after the swallow) or 3 (same anatomic "level" as 2, but with visible postprandial laryngeal residue). There were no 4 or 5 scores (material contacts the vocal folds without (4) or with(5) visible laryngeal postprandial residue). A single aspiration event was observed in the old group only (PAS score = 7, aspiration with responsive cough that did not clear tracheal residue).

Events...described as transient would probably be scored 2 and 4 on the PA scale because no residue is left behind in the larynx, whereas 3 and 5 (4 and 5-material contacts the vocal folds) indicate visible laryngeal postprandial residue. The scale was published in an effort to standardize these descriptions of swallowing airway compromise viewed with videofluoroscopic instrumentation.

Reference List

Rosenbek, J. C., Robbins, J. A., Roecker, E. B., Coyle, J. L., & Wood, J. L. (1996). A penetration-aspiration scale. Dysphagia, 11, 93-98."

My comments: Post-prandial usually refers to "after the meal," but I think J.L. Coyle is referring to post-swallow residue remaining in the laryngeal vestibule here.