Aspiration

What Is Aspiration?

Aspiration is when something you swallow "goes down the wrong way" and enters your airway or lungs. It can also happen when something goes back into your throat from your stomach. But your airway isn’t completely blocked, unlike with choking.

People who have a hard time swallowing are more likely to aspirate. More than 15 million Americans have trouble swallowing, called dysphagia. It can be temporary or part of a more serious condition.

People who might aspirate often or have problems swallowing include those who are older adults, who have had a stroke, and who have developmental disabilities.

Aspiration Symptoms

Sometimes, there’s no clear sign that food or liquid is going down the wrong way. Because you don't notice it, you don't cough. But in most cases, you:

• Feel something stuck in your throat
• Hurt when you swallow, or it's hard to do
• Cough while or after you eat or drink
• Feel congested after you eat or drink
• Have a gurgling or "wet-sounding" voice when you eat

Other signs are:

• Too much saliva in your mouth
• Chest discomfort or heartburn
• Shortness of breath or fatigue while eating
• Fever within a half-hour of eating
• Frequent pneumonia
• Trouble chewing

Aspiration Causes and Risk Factors

Your chances of aspiration go up with age, since you may have more trouble chewing and swallowing as you get older.

Other things that can cause you to aspirate are:

• Seizures
• Fatigue
• Acid reflux
• A loss of mental ability
• Loss of muscle tone or coordination that interferes with how well you chew or swallow
• Reaction to medication
• Throat cancer
• Head and neck injuries
• Stroke
• Nervous system disorders like amyotrophic lateral sclerosis (ALS), Parkinson's disease, and multiple sclerosis
• Eating or drinking too fast
• Dental problems
• Mouth sores
• Radiation or chemotherapy for your throat or neck
• Frequent vomiting
• Breathing machines or feeding tubes

Some children have trouble swallowing because of throat muscle problems caused by:

• Physical conditions such as a cleft palate
• Delayed growth
• Brain damage
• Nerve problems
• Muscle diseases like spinal muscular atrophy

Common symptoms of aspiration in babies and children include:

• Weak sucking
• Red face, watery eyes, or grimacing while feeding
• Breathing that speeds up or stops while feeding
• Slight fever after feeding
• Breathing problems like wheezing
• Frequent lung or airway infections

Aspiration Diagnosis

Your doctor will ask about your symptoms and do a physical exam. They might look closely at your mouth and cheeks. They may also recommend that you see a specialist called a speech-language pathologist, who can check for problems with your swallowing muscles.

You might have tests such as:

• X-rays. These can give your doctor an image of how much material you’ve breathed in.
• Bronchoscopy. Your doctor gives you medicine to relax and puts a thin tube called a bronchoscope down your throat. It has a tiny camera to take images of the insides of your lungs.
• Modified barium swallow (MBS). A technician takes X- rays of your throat and esophagus while you swallow foods and liquids that have been mixed with a chemical called barium.
• Fiber-optic endoscopic evaluation of swallowing (FEES). A specialist numbs your nose. They put a thin, flexible tube called an endoscope through it and into your throat. A camera inside it takes pictures while you swallow saliva, food, and liquids.
• Pharyngeal manometry. With your nose numbed, a technician puts a tube called a catheter through it and into your throat. The catheter has sensors to measure the pressure in your throat and esophagus when you swallow.

Complications of Aspiration

Aspiration can lead to more severe issues like infection and tissue damage. For example, aspiration pneumonia is a lung infection that causes inflammation and buildup of fluid. Symptoms may come on slowly. Without treatment, they can become dangerous.

Signs of aspiration pneumonia include:

• Frequent coughing with smelly mucus
• Shortness of breath
• Fever or chills and severe sweating
• Chest pain when you cough or take a deep breath
• Confusion, anxiety, and fatigue
• Feeling of suffocation

Over time, aspiration can also lead to dehydration, malnutrition, and weight loss, as well as higher chances of other illnesses.

Aspiration Prevention

Try these tips to avoid aspiration when you swallow:

• Eat only when you're alert and relaxed.
• Cut your food into small pieces.
• Eat smaller meals, and eat more often.
• Add moisture, like sauce, to dry food.
• Always swallow before you take another bite.
• Avoid foods that stick together.
• Don't talk while you eat or drink.
• Don’t eat or drink while lying flat.
• Use good posture while eating.
• Take care of your mouth and teeth. See your dentist regularly.
• Don’t smoke.

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