VIDEOFLUOROSCOPIC EVALUATION OF ASPIRATION WITH VISUAL EXAMINATION OFTHE GAG REFLEX AND VELAR MOVEMENT

The purpose of the present study was to investigate the relationship b etween prevalence of aspiration as determined by videofluoroscopic eva luation and prevalence of the gag reflex and velar movement as determi ned by direct visual examination. One hundred adult patients underwent a videofluoroscopic evaluation of aspiration with either an esophagra m (n = 31), upper gastrointestinal series (n = 18), small bowel series (n = 23), or modified barium swallow procedure (n = 28), and concomita nt evaluation of the gag reflex and velar movement on phonation. All s tudies were performed using the lateral, upright position, and ail pat ients drank at least 5 cc of single contrast barium. Aspiration was de fined as penetration of material below the level of the true vocal for ds. A normal gag reflex and normal velar movement on phonation were ob served in 14 of 15 (93%) patients who exhibited objective documentatio n of aspiration with videofluoroscopy. Conversely, 19 of 20 (95%) pati ents without a gag reflex were observed with videofluoroscopy to be wi thout aspiration. Normal velar movement on phonation was observed in 9 9 of 100 (99%) patients. There was no significant age difference betwe en patients with or without a gag reflex. No relationship was found be tween the prevalence of aspiration and the gag reflex or velar movemen t on phonation. It was concluded that the presence of a gag reflex doe s not protect against aspiration, and the absence of a gag reflex does not predict aspiration.