When food or liquid enters the laryngeal vestibule but, unlike with aspiration, does not descend below the level of the vocal cords themselves. Laryngeal penetration alone would be an indication of mild swallowing dysfunction, but it would not by itself create a risk of pneumonia, as aspiration might.
Photos of laryngeal penetration:
Laryngeal penetration (1 of 1)
After the patient swallowed several boluses of blue-stained applesauce, there were traces visible on the laryngeal surface of the epiglottis, indicative of penetration into the earliest part of the airway. By itself, soiling of the laryngeal vestibule to this minor degree does not threaten the person’s ability to eat by mouth.
Coughing (1 of 4)
This patient is annoyed by occasional coughing when she sips liquids. She has had no pneumonias, weight loss, or increased time required to eat/drink. Here, the patient has just taken a sip of blue water and holds it in her mouth.
Coughing (2 of 4)
Just before swallowing, a tiny drip of blue water “gets away” and begins to trickle down into her throat. Vocal cords remain unsuspectingly open.
Coughing (3 of 4)
The drip (arrow) has now reached the left aryepiglottic fold, which is the “side of the boat” that keeps liquid out of the airway. The drip looks smaller than in photo 2 because it is farther away. She does not cough.
Coughing (4 of 4)
During a different swallow, if a much larger amount of water were to drip prematurely down into her throat, a part of it would enter the laryngeal entrance and provoke coughing. If coughed back up, there would be little risk of pneumonia.
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