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1. Aspiration is the entry of a substance through the vocal folds (true vocal cords) into the trachea.

2. Aspiration is missed on bedside swallowing evaluations in 40% to 60% of patients (i.e. silent aspiration).

3. It can be reliably diagnosed on a VFSS. Aspiration will show penetration of contrast material below the true vocal cords.

4. Aspiration has been found to occur in 40% to 70% of stroke patients on VFSS.

5. Predictors of aspiration on VFSS include: delayed initiation of the swallow reflex, decreased pharyngeal peristalsis.

6. Predictors of aspiration on bedside swallowing exam: abnormal cough, cough after swallowing, dysarthria, dysphonia, voice change after swallow (wet voice), abnormal gag reflex.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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