ASPIRATION

Aspiration occurs when food or saliva enters the airway and lungs. Aspiration can cause pneumonia, or lung infection which causes shortness of breath, and lead to other infections and possibly death. There are numerous reasons for aspiration and it is best to treat the cause of the aspiration.

Symptoms of aspiration include:

Coughing while eating
Sensation that food or saliva travels down “the wrong pipe”
Frequent pneumonias

Evaluation for aspiration includes:

Laryngoscopy and stroboscopy – The treating physician should ensure that a vocal fold paralysis or any other anatomic conditions are not the cause of aspiration.

A swallowing study including a modified barium swallow study or a flexible endoscopic evaluation of swallowing may be performed to confirm the diagnosis of aspiration. During a modified barium swallow study, swallowed contents may be seen to travel between the vocal folds into the lungs. During flexible endoscopic evaluation of swallowing colored food products may be seen to travel into the trachea.

Treatment of aspiration may include:

Dietary changes – Thicker foods such as applesauce are easier to swallow and more difficult to aspirate than thin liquids such as water. Adding thickener to foods may make it easier to swallow.

Swallowing therapy – a speech pathologist works with a patient to strengthen the muscles of swallowing and teach good habits during eating that may minimize aspiration.

Tracheotomy – A tracheotomy does not treat the cause of the aspiration; however it may assist in two ways.

• Aspirated contents, often saliva, can be suctioned or removed from the airway through the tracheotomy tube.
• An inflated balloon around the tracheotomy tube may act as a mechanical barrier, preventing saliva from entering the airway. However, it has been shown that despite this barrier some contents are still aspirated.

Gastrostomy tube placement – In some individuals food and liquid that is swallowed enters the airway easily. A stomach tube, or G tube, is surgically placed to allow feeding to occur, bypassing the mouth throat and larynx.

Laryngectomy – In this surgery the voice box is removed and a permanent tracheotomy is created. The respiratory and digestive tracts are separated and food and saliva can longer enter the airway. Removing the voice box prevents a patient from speaking normally – however, alternative mechanisms of speech are possible to perform which are very intelligible.

Laryngotracheal separation – In this surgery a tracheotomy is performed. The trachea above is closed off. This also removes a person’s normal ability to speak. In theory, this is a reversible procedure.