[Dysphagia] Silent aspiration

[wabeach at hsc.vcu.edu (Woodford Beach)]

Absolutely correct. Pneumonia has multiple etiologies. Aspiration is only a
vector. To contract aspiration pneumonia you must have colonized bacteria in
the oral cavity as well as an impaired immune system (see Langmore, et al.,
1998. Predictors of aspiration pneumonia: how important is dysphagia.
Dysphagia, 13:69-81. See also all the references that Irene Campbell Taylor
refers to over the years). Thus, silent aspiration is not enough to explain
pneumonia unless other etiologies are ruled out (unfortunately doctors often
don't bother to look for HAP, or reflux, etc. once they have a possible
suspect).

Woodford A. Beach, Ph.D., CCC/SP
Senior Speech Pathologist
Adjunct Asst. Professor, Neurology
Adjunct Asst. Professor, Physical Medicine and Rehabilitation
Assistant Clinical Professor, Otolaryngology/Head and Neck Surgery
Asst. Clinical Professor, Otolaryngology/Head & Neck Surgery
Virginia Commonwealth University Medical Center
Richmond, VA 23298
Phone: 804-828-0207
Fax: 804-828-8281

----- Original Message ----- 
From: "Dailey, Scott" <scott-dailey@uiowa.edu>
To: "M. Tervo" <tervomm@yahoo.com>; <dysphagia@b9.com>; <LCDM11@aol.com>
Sent: Friday, November 11, 2005 6:39 PM
Subject: RE: [Dysphagia] Silent aspiration


> 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
>
> This e-mail (including any attachments) is covered by the Electronic
> Communications Privacy Act, 18 USC. 2510-2521. It is confidential and
> may be legally privileged. If you are not the intended recipient, you
> are hereby notified that any retention, dissemination, distribution, or
> copying of this communication is strictly prohibited. Please reply to
> the sender that you have received the message in error, and then delete
> it. Thank you.
> -----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
>
>
>
>
>
> ---------------------------------
>  Yahoo! FareChase - Search multiple travel sites in one click.
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>
>
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
>
>