[Dysphagia] How to identify silent aspiration clinically

[eripley at yahoo.com (Irene Campbell-Taylor)]

  There was a recent discussion about silent aspiration and how to tell if it is happening. In answer to the several private messages I have received, please see the following:
  "Aspiration: cause and implications. Otolaryngol Head Neck Surg. 1999 Apr;120(4):474-8.Lundy DS, Smith C, Colangelo L, Sullivan PA, Logemann JA, Lazarus CL, Newman LA, Murry T, Lombard L, Gaziano J.
The purpose of this investigation was to determine the overall prevalence of aspiration in dysphagic individuals referred for a modified barium swallow and the underlying anatomic and/or physiologic causes. A total of 166 patients were seen during a 1-month period at 5 participating institutions. Aspiration was detected in 51.2% of the patients. The most common causes were decreased laryngeal elevation and delayed triggering of the pharyngeal motor response. A history of aspiration pneumonia was significantly associated with the presence of aspiration on modified barium swallow study. The presence of a protective cough was present in only 53% of patients who aspirated, reinforcing the need for appropriate radiologic assessment in patients with suspected dysphagia." 
  The last sentence, of course, is inaccurate when and if clinicians are taught properly how to do a clinical exam. I am assuming that by ?laryngeal elevation? the authors really mean ?anterior hyoid movement with attached laryngeal movement?. This is easy to detect by palpation clinically (and is of course, the most common cause of aspiration) as well as a timed delay on the structured water swallowing test. These together give a better than 85% chance of identifying ?silent? aspiration as I have been demonstrating for about 20 years. When signs such as specific types of dysarthria/dysphonia, eye signs and cranial nerve abnormalities are added to the exam, as well as all other medical info., the certainty approaches 100%. 



Dr I Campbell-Taylor
Clinical Neuroscientist
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