Aspiration from Dysphagia

Aspiration from Dysphagia

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Aspiration from Dysphagia

Aspiration is when something enters your airway or lungs by accident. It may be food, liquid, or some other material. This can cause serious health problems, such as pneumonia. Aspiration can happen when you have trouble swallowing normally. This is known as dysphagia.

What happens when you swallow?

When you swallow food, it passes from your mouth down into your throat. This is called the pharynx. From there, the food moves down through a long tube (esophagus) and into your stomach. This journey is made possible by a series of actions from the muscles in these areas.

The pharynx is also part of the system that brings air into your lungs. When you breathe, air enters your mouth and moves into the pharynx. The air then goes down into your main airway (trachea) and into your lungs. A flap of tissue called the epiglottis sits over the top of the trachea. This flap blocks food and drink from going down into the trachea when you swallow.

What causes aspiration?

Aspiration from dysphagia is caused when the muscles in your throat don’t work normally. This lets food or drink enter the trachea when you swallow. This can happen as food goes down when you swallow. Or it can happen if food comes back up from your stomach.

When a person has dysphagia, aspiration is always a risk. You may be at risk for aspiration from dysphagia if you have any of these medical conditions:

  • Stroke

  • Severe dental problems

  • Conditions that lead to less saliva, such as Sjogren’s syndrome

  • Mouth sores

  • Parkinson disease or other neurologic conditions

  • Muscular dystrophies

  • Blockage in the esophagus, such as a growth from cancer

Symptoms of aspiration from dysphagia

Some people who aspirate do not have any signs or symptoms. This is called silent aspiration. But aspiration can cause symptoms such as:

  • Sense of food sticking in your throat or coming back into your mouth

  • Pain when swallowing

  • Difficulty starting a swallow

  • Coughing or wheezing after eating

  • Chest discomfort or heartburn

  • Fever 30 minutes to an hour after eating

  • Too much saliva

  • Feeling congested after eating or drinking

  • Having a wet-sounding voice during or after eating or drinking

  • Shortness of breath or tiredness while eating

  • Vomiting blood

  • Pneumonia that comes back again and again

Symptoms can happen right after eating. Or they may happen over time. You may not have all of these symptoms. They may depend on how often and how much food or drink you aspirate.

Diagnosing aspiration from dysphagia

You will need to be checked for aspiration from dysphagia if you have symptoms. You may also need to be checked if you have had a stroke or other health problem that can cause trouble swallowing. If your health care provider thinks you may be aspirating, you may be told to not eat or drink until you are tested.

Your health care provider will ask about your medical history and symptoms. This may be done by a speech-language pathologist (SLP). The SLP will try to find out if you have problems with the lower or upper part of your swallowing muscles. The SLP may ask about what foods or drink cause problems, and when your symptoms occur.

You may have a physical exam. This may include an exam of your teeth, lips, jaws, tongue, and cheeks. You may be asked to move these areas in certain ways and make certain sounds. Your SLP may also test how you swallow different types of liquids and solids.

You may also need one or more tests. These can help to find the cause of your dysphagia. Tests are often very helpful in showing cases of silent aspiration. The test may include:

  • Modified barium swallow test (MBS), to show if material is going into your lungs

  • Fiberoptic endoscopic evaluation of swallowing (FEES), which can also show if material is going into your lungs

  • Pharyngeal manometry, to check the pressure inside your esophagus

Treatment for aspiration from dysphagia

Your health care provider will try to treat the cause of your dysphagia. This may include using medicines. In some cases, surgery may be able to treat the cause of dysphagia.

You may also need to manage the symptoms of dysphagia. This may include doing things such as:

  • Changing your diet. You may need to make liquids thicker or not have liquids.

  • Changing your position while eating. For example, you may need to eat sitting upright, tilt your head back, or bend your head forward.

  • Not eating in bed

  • Eating smaller bites of food

  • Eating with someone watching you

  • Not talking while eating

  • Not being distracted during meals

  • Eating when you are most alert

  • Using tools such as straws

  • Doing exercises to strengthen your lips and tongue

  • Using special swallowing techniques

As you recover, you may need to use fewer of these methods. Dysphagia after a stroke may improve greatly over time.

You may still be at high risk for aspiration even with these methods. If this is the case, you may need to use a feeding tube for a period of time to prevent aspiration.

What happens if you don’t get treated?

A major complication of aspiration is harm to the lungs. When food, drink, or stomach contents make their way into your lungs, they can damage the tissues there. The damage can sometimes be severe. Aspiration also increases your risk for pneumonia. This is an infection of the lungs that causes fluid to build up in the lungs. Pneumonia needs to be treated with antibiotics. In some cases, it may cause death.

Other possible complications from dysphagia include:

  • Dehydration

  • Malnutrition

  • Weight loss

  • Increased risk for other illness

These problems can reduce your level of independence. They may also cause or lengthen a stay in the hospital.

Preventing aspiration from dysphagia

You can help prevent aspiration by:

  • Taking good care of your mouth and teeth

  • Getting dental treatment, such as dentures, when needed

  • Taking medicines as advised

  • Stopping smoking

  • with good posture when eating and drinking

  • Doing oral exercises as advised by the SLP

  • Making changes to your diet as advised by the SLP

  • Asking your doctor for other advice to prevent aspiration in your case