[Dysphagia] How to identify silent aspiration clinically

[Heidi.Bassani at amedd.army.mil (Bassani, Heidi D Ms WRAMC-Wash DC)]

I would like to see  your data on this 85%-100% certainty.  In what
peer-reviewed journal is it published? 

-----Original Message-----
From: Irene Campbell-Taylor [mailto:eripley@yahoo.com] 
Sent: Tuesday, January 10, 2006 2:30 PM
To: dysphagia@b9.com
Subject: [Dysphagia] How to identify silent aspiration clinically

  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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