Approaches to the patient with aspiration and swallowing disabilities

Abstract

Aspiration, or soiling of the tracheobronchial tree, can produce life-threatening pulmonary disease. Intermittent or persistent aspiration may cause symptoms including cough, intermittent fever, recurrent tracheobronchitis, atelectasis, pneumonia, and/or empyema. The pulmonary disease may be associated with weight loss, cachexia, and dehydration. In many cases the aspiration is caused by laryngeal dysfunction, allowing pulmonary contamination by swallowed material. In other cases the aspiration is caused by a dysfunction of the oral, pharyngeal, or esophageal phases of swallowing. In some cases the aspiration is caused by a combination of laryngeal and swallowing dysfunction. Geriatric patients are more likely to experience aspiration, since muscle weakness causing mechanical disability and neurologic impairment are more common in this age group. Therefore, with the ever-increasing aging of our population, these disabilities will be on the rise, with an associated increase in pulmonary disease and death. The approach to evaluation and management of these disorders must be based on an understanding of the underlying functional impairment.

Neural activation of swallowing and swallowing‐related tasks in healthy young adults: An attempt to separate the components of deglutition

“…After the bolus has been formed, the tip of the tongue is elevated toward the superior alveolar ridge while the soft palate elevates and the posterior tongue depresses [Dodds et al, 1990;Shaker et al, 1988]. The bolus is then propelled to the oropharynx as the tongue pushes the bolus superiorly and posteriorly [Blitzer, 1990;Dodds et al, 1990]. The pharyngeal stage involves the transportation of the bolus from the oropharynx and around a closed laryngeal cavity into the esophagus [Perlman and Christensen, 1997].…”

A Randomized Control Study to Determine the Effects of Unlimited Oral Intake of Water in Patients with Identified Aspiration

“…Blitier ( 14) duescribed the neurology and physiology of the cough reflex, Logemann ( 15 ) reported that 40 percent of dysphagic patients who aspirated did so silently, without a cough reflex or clinical manifestations. Silent, subglottic aspiration has been reported by Splaingard and cu-wurkers ( 16), Linden and cu-wurkers ( 17), and Horner and coworkers (18).…”

Epiglottic Dysfunction: Abnormal Epiglottic Movement Patterns

“…Of the 225 patients who aspirated, 38% had either an immediate cough re¯ex at the vocal folds (recurrent laryngeal nerve) or a delayed tracheal cough (vagal nerve) [35]. The remaining 62% of patients aspirated without a cough re¯ex.…”