The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy

An absent gag reflex is often employed clinically as an indicator of aspiration risk. Dysphagia clinic records of 120 neurological patients who had undergone speech therapy and ENT assessment, followed by videofluoroscopy, were retrospectively analysed to ascertain if any link between an absent gag reflex and aspiration could be demonstrated. No association between an absent gag reflex and aspiration or laryngeal overspill was found (Mann-Whitney U-test; 2-tailed P = 0.11). Abnormalities on indirect laryngoscopy were seen in 34/120 patients (28%), and these were more closely related to aspiration risk (Mann-Whitney U-test: 2-tailed P = 0.06). An absent gag reflex is not a useful predictor of aspiration, and assessment of the gag reflex should not be relied upon to predict airway safety. However, indirect laryngoscopy is a useful adjunct to standard speech therapy assessment of the dysphagic patient.