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Silent Aspiration: Results of 1,000 Videofluoroscopic Swallow Evaluations

Senior Speech Pathologist, Bethesda Lutheran Hospital and Rehabilitation Center

Molly Engle

Associate Professor, Behavioral Medicine Unit, The University of Alabama at Birmingham

Charles Ormiston

Medical Director, Neurology, Bethesda Lutheran Hospital and Rehabilitation Center

Objective: To measure the percent of aspiration and "silent" aspiration (no cough reflex) in a population of 1,000 patients from multiple neurological pathology groups.

Design: A retrospective analysis of outcomes of 1,000 videofluoroscopic swallow eval uations completed over a ten-year period (1984-1994).

Setting: Acute primary care and rehabilitation hospitals.

Patients: One thousand patients who were referred for videofluoroscopic swallow eval uations by their physicians due to concern regarding swallow function. Patients from an acute care setting numbered 820; 180 patients were from a rehabilitation hospital setting. Patients were from 26 neurologic diagnostic categories. Ages ranged from 15 to 104 years, mean 72.1 ± 15.5 years. Of the 1,000 patients, 502 patients were female, 467 were male, and 31 did not have gender recorded. Ethnic distribution was as follows: 645 were Euro-American, 17 were African-American, 4 were Hispanic-American, 2 were Asian-American, 2 were "other," and 330 did not have ethnicity recorded.

Interventions: None.

Main Outcome Measure:The primary study outcome measurements as planned before data collection were (1) to determine the percent of aspiration on a varied popula tion of patients referred for videofluoroscopic swallow evaluations; and (2) to deter mine the percent of patients who aspirated "silently" without a cough reflex.

Results: Of the total population of 1,000 patients evaluated, 573 patients (57%) aspi rated. Of the 573 patients who aspirated, 296 (52%) aspirated silently, without a pro tective cough reflex, awareness, or clinical indications of distress (breakdown by pathology included in Tables 1 and 2).

Conclusions: Fifty-two percent (296/573) of patients who aspirated did so without clini cal indications of coughing, choking, or awareness of their aspiration. These patients are at high risk for developing aspiration-related complications, pneumonia, or death due to the fact that their aspiration pathology is generally not diagnosed until they develop severe indications of illness along with medical complications. These patients are at high risk for extended acute care hospitalization at increased financial expense if they develop pneu monia or complications. Bedside swallow screening tests and observations are presently not accurate enough to assess those patients who have reduced laryngeal sensation, with no cough reflex, especially when severe illness and death are potential outcomes. Lib eral, early use of videofluoroscopic swallow evaluation is recommended to insure that patients from high risk aspiration groups are diagnosed early, before added medical com plications occur.

Key Words: Key Words: Aspiration—Silent aspiration—Swallow dysfunction.

Neurorehabilitation and Neural Repair, Vol. 10, No. 2, 121-126 (1996)
DOI: 10.1177/154596839601000207


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