01/20/2026
It’s tempting to feel reassured when a swallow study shows no aspiration, but swallowing safety is more complex than a single outcome variable.
✔️ Absence of aspiration does not equal normal swallowing.
Airway safety exists on a continuum, and patients may demonstrate clinically significant impairment even when material does not pass below the vocal folds.
Here’s why:
👉Pe*******on still matters.
Repeated or deep laryngeal pe*******on is associated with increased aspiration risk, especially when clearance is incomplete or inconsistent. Pe*******on events may precede aspiration as swallowing function declines.
👉Residue increases post-swallow aspiration risk.
Pharyngeal residue can migrate into the airway after the swallow, particularly with changes in posture, respiration, or fatigue. A PAS score alone does not capture this risk.
👉Frequency and pattern are critical. A single “clean” swallow does not reflect real-world eating. Intermittent airway invasion, fatigue effects, and variability across trials are key components of swallowing safety.
👉 Safety ≠ efficiency. A swallow can be “safe” in the moment yet inefficient, requiring compensations, repeated swallows, or excessive residue, all of which impact nutrition, hydration, and long-term pulmonary risk.
🔎 This is why instrumental interpretation must extend beyond “aspirated vs. did not aspirate.”
Comprehensive analysis includes airway invasion pattern, residue severity, timing, clearance, and physiologic impairment.
Swallowing is not binary.
And neither is safety.
