[Dysphagia] Silent aspiration

[scott-dailey at uiowa.edu (Dailey, Scott)]

It is entirely possible that the aspiration noted on the MBS is not what
resulted in his pneumonia but is related to his changes in status.  He
may have been aspirating small amounts prior to surgery without adverse
complications.  With the physiologic stress of a surgery leading to
decompensation and altered immune response, the aspiration could lead to
pneumonia due to the surgery.  And on the other hand, he may not have
aspiration pneumonia at all, but hospital acquired pneumonia or
pneumonia related to his post surgical recovery that led to mental
status changes, especially if he had some neurologic symptoms before.
And there are always the influences of medications that he may have been
or is receiving now that may contribute to dysphagia. 

Scott

Scott Dailey, M.A., CCC-SLP
Speech-Language Pathologist II
University of Iowa Hospitals & Clinics
200 Hawkins Dr
Iowa City, IA 52242
(319)356-7030

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-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On
Behalf Of M. Tervo
Sent: Friday, November 11, 2005 4:18 PM
To: dysphagia@b9.com; LCDM11@aol.com
Subject: Re: [Dysphagia] Silent aspiration

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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