Physiological factors related to aspiration risk: a systematic review

Dysphagia. 2014 Jun;29(3):295-304. doi: 10.1007/s00455-014-9516-y. Epub 2014 Feb 23.


Penetration-aspiration is considered the most serious component of oropharyngeal dysphagia. Clinicians regularly evaluate the pathophysiology of swallowing and postulate reasons or mechanisms behind penetration-aspiration. In this article we share the results of a two-stage literature review designed to elucidate the association between abnormalities in physiological measures of swallowing function and the occurrence of penetration-aspiration. In the first stage, a broad scoping review was undertaken using search terms for nine different structures involved in oropharyngeal swallowing. In the second stage, based on the results of the initial search, a more focused systematic review was undertaken which explored the association between aspiration and abnormalities in respiratory, tongue, hyoid, and laryngeal function in swallowing. A total of 37 articles underwent detailed quality review and data extraction in the systematic review. The results support measurement of tongue strength, anatomically normalized measures of hyoid movement, bolus dwell time in the pharynx while the larynx remains open, respiratory rate, and respiratory swallow phasing as parameters relevant to aspiration risk.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Deglutition / physiology*
  • Deglutition Disorders / complications
  • Deglutition Disorders / physiopathology*
  • Humans
  • Hyoid Bone / physiopathology
  • Larynx / physiopathology
  • Respiration*
  • Respiratory Aspiration / etiology*
  • Respiratory Aspiration / physiopathology*
  • Risk Factors
  • Tongue / physiopathology