Aspiration

Craig H. Zalvan

Aspiration refers to the inhalation of particulate matter, fluid, or secretions into the trachea, bronchi, and lungs. It can be a process that is transient and short lived (acute) or can persist over time (chronic). The etiology of aspiration is highly variable and includes neurological conditions, mental status changes, anatomical changes, infection, ingestion of toxic substances, and traumatic or iatrogenic causes.

Symptoms of aspiration, many of which are nonspecific, can be obvious and clinically evident, or they can be silent. Typically, penetration and aspiration of contents through the vocal folds into the airway elicit coughing or choking. If normal protective mechanisms are impaired, this response is lost. Subclinical or silent aspiration refers to aspiration occurring without any outward sign or symptom of aspiration.

Aspiration, whether acute or chronic, can lead to significant morbidity, including pneumonia, pulmonary fibrosis, pulmonary hypertension, hypoxia, asphyxia, and death.

Signs and Symptoms

As mentioned, the signs and symptoms of aspiration can be subtle and nonspecific. In cases of silent aspiration, there may be no indication of aspiration other than a comorbidity such as pneumonia or hypoxemia. The most common presentation of aspiration is coughing associated with oral intake, usually liquids. Many of the signs and symptoms associated with aspiration are associated with the underlying etiology, as opposed to the aspiration itself.

Esophageal: Typically, esophageal signs and symptoms are associated with underlying esophageal dysmotility or obstruction leading to aspiration.

Dysphagia

Globus sensation

Odynophagia

Prolonged eating time

Regurgitation

Laryngeal: The larynx serves several purposes, including phonation, respiration, and airway protection. Pathology that affects the larynx alters these processes, leading to several signs and symptoms.