[Dysphagia] Silent aspiration

[tervomm at yahoo.com (M. Tervo)]

Thank you that was helpful....I guess the reason the question came up was I saw a pt post left knee surgery who had a pneumonia.  He had a history of possible Parkinson's however this was not a confirmed dx.  Actually the family stated that they ruled it out and considered it a benign tremor.  The only medical history was cardiac, but no diagnoses that would indicate dysphagia other than the current pneumonia.  Post surgery the pt had a declining status with confusion, impulsivity, and ataxic gait...however no CVA showed up on the CT.  No signs or symptoms of a pharyngeal phase dysphagia (no coughing, no gurgly voice, and lung sounds were already crudy due to pneu).  The Dr. ordered a MBS and the pt was aspirating every consistency.  This pt was a bit of a puzzle anyway due to post surgery status...and I'm somewhat new to the field....so I wanted to learn how I could avoid overlooking a pt who is silently aspirating because at the time I felt like I had covered all the bases.  

LCDM11@aol.com wrote:I guess being an SLP makes one sooo type A...never thought I'd get that way but...
 
I believe that cervical auscultation is most certainly one tool to have and can be useful in some cases. My humble opinion is that looking a medical diagnosis (R CVA, respiratory illness, cancer -- look at type of resection, chemo and/XRT -- etc.) severity of diagnosis, and looking at delayed cough response (timed in secs) are important tools to use. 
 
As you may already know, R CVAs have a tendency to "silently" aspirate. I believe that a Logemann article (don't recall the year of the study) defined silent aspiration as a cough after "30 secs" (again, not sure on the actual time--you may want to look that up and verify).
 
Furthermore, some cancer patients (of the larynx, tongue, neck etc) have good lung status, strong, productive coughs etc. (this does not of course include the "smokers."), so you will see a strong delayed cough afterwards. I've seen this in a lot of R CVAs as well. With these patients, I have found that some ENTs are not as likely to place them NPO just because they aspirate because, their natural ability is to cough it out -- and some do it effectively. However, these patients have said to me that it eventually is uncomfortable and embarassing to cough so strongly during meals. I guess that's another story.
 
So to answer your question: medical diagnosis, lung status, current overall condition of the patient -- can they tolerate any aspiration at all -- what is termed "silent" or otherwise, and looking at the elapsed time of delayed coughing. I've also seen increased drooling as well -- in an otherwise, non-drooling patient (again, I think it was the Logemann article that refers to this.)
 
Just my 2 cents,
Debbie
 
 


		
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