Aspiration Across Different Aetiologies and Phonatory Gap Configurations: A Descriptive Cross-sectional Study

Introduction: Phonatory gap, resulting from incomplete glottic closure, is a common laryngeal finding in patients presenting with dysphonia. Beyond its well-documented impact on voice quality, incomplete glottic closure may also compromise airway protection during swallowing, predisposing patients to laryngeal penetration and aspiration. Aim: To characterise the distribution of aspiration across different aetiologies and phonatory gap configurations. Materials and Methods: The present cross-sectional descriptive study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery at Sri Siddhartha Medical College, Tumkur, Karnataka, India, from February 2025 to February 2026. Seventy adult patients with voice-related complaints and phonatory gap on videolaryngoscopy were enrolled. The aetiology and configuration of phonatory gap were documented. Aspiration was defined as passage of test material below the true vocal folds, quantified using the Penetration-Aspiration Scale (PAS), a score ≥6 was recorded as aspiration-positive. The swallowing assessment included a clinical evaluation and a Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Continuous variables are reported as mean±Standard Deviation (SD). Categorical variables are presented as frequencies and percentages. Results: The 51-70 year age group comprised 30 patients (42.9%), while 46 patients (65.7%) were male. Posterior phonatory gap was the most common configuration, observed in 12 patients (42.8%). Unilateral vocal fold paralysis was the most frequent aetiology, occurring in 23 patients (32.9%), followed by presbylaryngis in 15 patients (21.4%). Aspiration was most frequent among patients with unilateral vocal fold paralysis (12/23, 52.2%), followed by those with presbylaryngis (6/15, 40.0%). Among phonatory gap configurations, posterior gaps (12/28, 42.8%) and spindle-shaped gaps (8/20, 40.0%) demonstrated the highest aspiration rates. Conclusion: The aetiology and configuration of phonatory gap are measurable associated factors of aspiration risk. Vocal fold paralysis and presbylaryngis, particularly when accompanied by posterior or spindle-shaped gaps, carry the greatest aspiration burden.