Chronic Aspiration Without Gastroesophageal Reflux as a Cause of Chronic Respiratory Symptoms in Neurologically Normal Infants

Sheikh, Shahid; Allen, Edward D.; Shell, Richard; Hruschak, Jean; Iram, Durdana; Castile, Robert G.; McCoy, Karen

doi:10.1378/chest.120.4.1190

Cited by 116 publications

(109 citation statements)

References 13 publications

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“…Arvedson et al [14] retrospectively reviewed VF results for 186 children with developmental dysphagia and found that 26% had aspirated (94% silently). Silent aspiration occurred on VF in 2/11 (18%) children with chronic gastroesophageal reflux [34] and has also been described in neurologically normal infants without reflux [35]. Traumatic brain injury can cause dysphagia and silent aspiration [36,37], and the prolonged endotracheal intubation/ventilation often required in such patients may contribute [38].…”

Section: Silent Aspiration In Nonstroke Diseasementioning

confidence: 92%

“…Pikus et al [71] retrospectively reviewed patients who had undergone VF and found that those with silent aspiration developed pneumonia more often than those with normal swallowing, although there was significant potential for selection bias in their patient group determination. One study of intubation injuries related silent aspiration to subsequent pulmonary complications [50], and in the group of normal infants found to have silent aspiration [35], improvement of respiratory function occurred only after resolution of dysphagia. Another study in older, bed-bound, institutionalized patients showed reduced pyrexial days (presumed respiratory infections) by mouth-cleaning and maintenance of an upright posture after meals [72] and concluded that this had reduced silent aspiration of pharyngeal secretions.…”

Section: Prognostic Significancementioning

confidence: 99%

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Silent Aspiration: What Do We Know?

2005

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Although clinically evident aspiration is common in subjects with dysphagia, a significant proportion may aspirate silently, i.e., without any outward signs of swallowing difficulty. This article reviews the literature on the prevalence, etiology, and prognostic significance of silent aspiration. An electronic database search was performed using silent aspiration, aspiration, dysphagia, and stroke as search terms, together with hand-searching of articles. Silent aspiration has been described in many conditions and subgroups of patients (including normal individuals), using a number of detection methods, making comparisons a challenge. The best data are for acute stroke, in which 2%-25% of patients may aspirate silently. Mechanisms associated with silent aspiration may include central or local weakness/incoordination of the pharyngeal musculature, reduced laryngopharyngeal sensation, impaired ability to produce a reflexive cough, and low substance P or dopamine levels. In terms of prognosis, silent aspiration has been associated with increased morbidity and mortality in many but not all studies. However, some degree of silent aspiration at night may be normal in healthy individuals. The phenomenon of silent aspiration is poorly understood and further research is needed to improve methods of detection and thereby better define its prevalence and prognostic significance.

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Section: Silent Aspiration In Nonstroke Diseasementioning

confidence: 92%

Section: Prognostic Significancementioning

confidence: 99%

Silent Aspiration: What Do We Know?

2005

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“…Aspiration secondary to swallowing dysfunction may also occur in neurologically normal infants. Sheikh et al (16) showed that 13 of 112 neurologically normal infants (11.6%) who were evaluated for recurrent stridor or wheezing had evidence of aspiration on videofluoroscopic swallowing studies.…”

Section: Discussionmentioning

confidence: 99%

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

et al. 2005

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“…80,81 It is unknown whether making this diagnosis benefits infants. The largest assessment of outcomes for neurologically impaired infants found that fundoplication did not reduce their risk of hospitalization for respiratory illness.…”

Section: Aspirationmentioning

confidence: 99%

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

et al. 2014

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Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.

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Chronic Aspiration Without Gastroesophageal Reflux as a Cause of Chronic Respiratory Symptoms in Neurologically Normal Infants

Cited by 116 publications

References 13 publications

Silent Aspiration: What Do We Know?

Silent Aspiration: What Do We Know?

Poly-lactic-glycolic Acid Microspheres: A Biodegradable Marker for the Diagnosis of Aspiration in Hamsters

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

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