Component 8: Laryngeal Elevation

Laryngeal Elevation is judged during initial elevation of the larynx and prior to the height of the swallow. Laryngeal
elevation is scored at the time the epiglottis reaches its MOST horizontal position. If there is no displacement of
the epiglottis to a horizontal position, laryngeal elevation is scored when the epiglottis is maximally displaced. In
the case of multiple or sequential swallows, each swallow is considered in formulating the OI score.
With any scale that uses descriptors rather than specific units of measurement, there will be variable difficulty
getting a feel for what is “minimal” versus what is “partial”, etc. The two extremes of the scores, (0), complete
superior movement, and (3), no superior movement, should be considered when developing concepts of (1), partial
superior movement, and (2), minimal superior movement, as these terms apply to laryngeal elevation. In general,
partial movement will be closer to complete movement in range of motion observed and minimal movement will
be closer to no movement.
The effect of laryngeal elevation is early closure of the laryngeal vestibule accomplished by approximation of the
forwardly displaced arytenoid cartilages to the posteriorly displaced epiglottic petiole or base. When scoring this
component, keep your eye on the following three structures:

1) Epiglottis

2) Epiglottic petiole 1

3) Arytenoid cartilages
2
3

SCORING EXAMPLES
The following images are intended to help you differentiate between Laryngeal Elevation scores 0-3. Remember,
laryngeal elevation is scored when the epiglottis reaches its most horizontal position or just after initial hyoid
movement if there is no displacement of the epiglottis.

(0) Full superior movement of the thyroid cartilage with complete approximation of the arytenoids to the epiglottic petiole:

In the image above, the epiglottis is at its most horizontal position and there is no visible air or contrast in the
laryngeal vestibule. The arytenoids are firmly pressed into the base of the epiglottis.

(1) Partial superior movement of the thyroid cartilage with partial approximation of the arytenoids to the epiglottic petiole:
In the images above, the arytenoids don’t quite make complete contact with the epiglottic petiole and a narrow
line of contrast (left) and air (right) is visible within the nearly closed laryngeal vestibule.

(2) Minimal superior movement of the thyroid cartilage with minimal approximation of the arytenoids to the epiglottic base:

In the image above, there is a significant amount of air that can be seen within the laryngeal vestibule with the
epiglottis at its most horizontal position. The laryngeal vestibule, base of the epiglottis and arytenoids are outlined
in contrast.

(3) No superior movement of the thyroid cartilage with no approximation of the arytenoids to the epiglottic base:

In the image above, the arytenoids and epiglottic petiole are clearly identified as there is no superior movement
of the thyroid cartilage and the laryngeal vestibule remains widely patent.

FREQUENT SCORING ERRORS

Timing the Score
In general, when scoring, remember to score when the epiglottis reaches its most horizontal position and use the
reference points above to assist your decision-making. Keep in mind the upper/vertical & forward/horizontal
nature of the hyolaryngeal complex. Be careful not to confuse the physiology involved in Laryngeal Elevation
(component 8) with that of Laryngeal Vestibular Closure (Component 11). Although both contribute to airway
protection, they will not always share similar levels of impairment.

Image 1 depicts the onset of hyoid excursion as the larynx begins

to rise. At this stage, the epiglottis has not quite reached its most
horizontal position. Be careful not to use this point in the
sequence to score Laryngeal Elevation (Component 8). Instead,
wait until the epiglottis has reached its most horizontal position
(as depicted in image 2).

2
While the tip of the epiglottis remains upright, the body of the
epiglottis has reached its most horizontal position. It is at this
point that you should score Laryngeal Elevation (Component 8).
Note the difference in the width of the contrast between the
epiglottic petiole and the arytenoids. There is significantly
greater approximation of the arytenoids to the epiglottic petiole
and consequent diminished contrast in the laryngeal vestibule.
You would assign a score of (1), partial superior movement of the
thyroid cartilage/partial approximation of the arytenoids to the
epiglottic petiole.

3
Image 3 captures the height of the swallow. The epiglottis does
not fully invert but it has passed beyond the horizontal position
and the hyoid has reached its maximum anterior-superior
displacement. It is at this point you would score Laryngeal
Vestibular Closure (Component 11). Remember, although
Laryngeal Elevation and Laryngeal Vestibular Closure are related,
do not confuse the specific physiology of one with the other
when scoring. In this sequence, the two components do not
share the same score as there is no air or contrast in the laryngeal
vestibule at the height of the swallow. Laryngeal Vestibular
Closure is scored (0), complete.