Though aspiration of small amounts of barium sulfate contrast medium is generally not regarded harmful it can cause pulmonary baritosis and aspiration of larger amounts may lead to death. Gastrografin) are contraindicated due to the significant risk of flash pulmonary edema. If a patient is at risk of aspiration the study should be performed with low osmolar water-soluble contrast medium (e.g. The absence of an appropriate cough reflex (indicating "silent aspiration") may be associated with higher morbidity 2. Needle aspiration may also be employed to prove the pres. In these situations, a cotton-plug technique is used, i.e., a small tuft of cotton is twisted at one end between fingers to make it pointy at one end. If a patient aspirates, one important factor is the presence of a sufficient cough reflex. To my parents, for teaching me the meaning of hard work and reminding me. Sometimes the precipitate is not fully packed after centrifugation and tends to go into supernatant during the decantation or aspiration process. The severity of aspiration can be graded using the penetration-aspiration scale. Postdeglutitive: aspiration occurs after the main bolus has passed the pharynx Insufficient larynx closure: reduced or delayed elevation of hyoid/larynx, incomplete epiglottic tilt, postoperative status, impaired pharyngeal clearance Intradeglutitive: aspiration occurs during the swallowing act Lack of bolus control: dorsal leaking, delayed initiation of swallowing reflex Predeglutitive: aspiration occurs before the swallowing reflex is initiated FluoroscopyĪ videofluoroscopic swallow study can visualize the timing, mechanism and extent of aspiration. Plain radiograph / CTįindings are discussed in the article on pulmonary aspiration diseases. Videofluoroscopic swallow studies allow direct observation and analysis of the aspiration event. Tracheoesophageal fistula: rare cause of aspiration in infantsĪspirated material and consequential lung pathology can be visualized with chest x-ray or CT. Meconium aspiration: a complication in newborns Unconscious patients are prone to aspiration of vomitus because of subdued/absent defensive reflexesįoreign body aspiration: frequently happens in toddlers tumor, after operation or radiation) and impaired pharyngoesophageal clearance are predisposing factors stroke, palsy of cranial nerves IX, X and XII or neurodegenerative diseases) can result in impaired coordination of deglutitionĪlterations of normal anatomy (e.g. Numerous pathologies can cause laryngopharyngeal dysfunction that predisposes to recurrent aspirations: when simultaneously talking and eating) and should provoke a vigorous cough reflex. EtiologyĪspiration usually happens during eating or drinking and may occasionally occur in healthy individuals (e.g. The timely elevation of the hyoid and larynx, as well as the posteroinferior tilt of the epiglottis, ensure that the laryngeal aditus is closed as the bolus of food/drink passes. The swallowing act is a well-coordinated and complex process, which, once initiated, is largely involuntary. If material enters the larynx but remains above the vocal folds, this is called penetration. The term aspiration is used if material passes below the level of the vocal folds, i.e.
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