Aspiration can be defined as the accidental entry of substances intended to reach the stomach into the respiratory tract. These materials, which mistakenly enter the respiratory system during swallowing, can reach the lungs and cause serious complications. Aspiration can occur due to various reasons.

What is Aspiration?

Under normal circumstances, food, saliva, or any other material passes through the pharynx, esophagus, and stomach. On the other hand, air taken through the nose or mouth passes through the pharynx, larynx, trachea, bronchi, and into the lungs. The correct passage of both swallowed substances and air is controlled by a small structure called the epiglottis. During breathing, the epiglottis moves upward, allowing air to pass directly into the larynx. During swallowing, the epiglottis tilts downward, covering the trachea and preventing substances from entering the respiratory tract.

Aspiration occurs when the balance and coordination between swallowing and breathing controlled by the epiglottis are disrupted. In aspiration, materials that should progress to the stomach accidentally enter the trachea, which can have serious health consequences.

Aspiration primarily affects infants, the elderly, and individuals with swallowing disorders. While aspiration may occur without any noticeable symptoms, it can sometimes lead to severe symptoms, such as:

  • Feeling of something stuck in the throat
  • Pain or difficulty swallowing
  • Coughing after eating or drinking
  • Sensation of choking while eating
  • Making gurgling sounds when swallowing

Additional symptoms that may develop in individuals experiencing aspiration include:

  • Excessive saliva in the mouth
  • Chest discomfort
  • Heartburn
  • Fatigue or shortness of breath while eating
  • Fever developing shortly after meals (within about 30 minutes)
  • Difficulty chewing
  • Frequent pneumonia episodes

Aspiration is also common in infants. Some aspiration symptoms in infants are:

  • Poor sucking reflex
  • Facial redness or grimacing during feeding, with watery eyes
  • Rapid or interrupted breathing while feeding
  • Mild fever after feeding
  • Wheezing and other respiratory problems
  • Frequent respiratory infections or pneumonia

What Causes Aspiration?

Aspiration can develop for different reasons in adults and infants.

Causes of Aspiration in Adults

The primary cause of aspiration in adults is impaired swallowing function. When swallowing does not occur normally, the mechanisms preventing aspiration may fail, leading to substances entering the respiratory tract. The main causes of aspiration in adults include:

  • Loss of Tongue Control: The tongue is a muscular organ controlled by nerves. Loss or weakening of this control can impair the swallowing reflex, leading to aspiration, especially of liquids.
  • Abnormal Swallowing Reflex: A dysfunctional swallowing reflex allows food or other materials to enter the airway.
  • Neurological Diseases: Conditions like Parkinson’s disease can impair tongue control and cause aspiration.
  • Esophageal Disorders: Problems with the esophagus, such as gastroesophageal reflux disease (GERD), dysphagia (painful swallowing), or throat cancer, can contribute to aspiration.
  • Neck Surgery: Surgical procedures affecting the larynx can disrupt swallowing. If the epiglottis is damaged, the coordination between breathing and swallowing may be compromised.
  • Oral and Dental Problems: Dental issues can impair chewing and swallowing, increasing the risk of aspiration.
  • General Anesthesia: During surgeries, the contents of the stomach may flow back into the respiratory tract, posing a risk of aspiration. Surgical teams take precautions to prevent this by requiring patients to fast before procedures.

Causes of Aspiration in Infants

In infants, aspiration often occurs due to swallowing dysfunction related to issues with the throat muscles. Conditions that may weaken the throat muscles in infants include:

  • Physical abnormalities like cleft palate
  • Growth retardation
  • Brain damage
  • Nerve damage
  • Neuromuscular disorders such as cerebral palsy or spinal muscular atrophy

What Are the Complications of Aspiration?

Aspirating solid or liquid substances can lead to serious health problems.

Aspiration Complications in Adults

Aspiration can result in severe issues, including infections and tissue damage. One of the most serious complications is aspiration pneumonia, which occurs when materials entering the lungs cause an infection. Aspiration pneumonia leads to inflammation and fluid accumulation in the lungs. Its symptoms may develop slowly over time and include:

  • Frequent coughing with foul-smelling sputum
  • Shortness of breath
  • Fever, sweating, and chills
  • Chest pain or the need to cough when taking deep breaths
  • Anxiety, fatigue, or confusion
  • Feeling of suffocation

Aspiration Complications in Infants

In infants, aspiration can lead to similar complications, including pneumonia. Additionally, chronic aspiration may result in dehydration, malnutrition, and weight loss.

How is Aspiration Diagnosed and Treated?

Early diagnosis and treatment of aspiration are crucial to prevent complications.

Diagnosis

If aspiration causes noticeable symptoms, it becomes easier to detect and diagnose. However, in some cases, symptoms may not be obvious, making diagnosis more challenging. The diagnostic process usually involves a patient interview and physical examination. The following methods may be used to diagnose aspiration:

  • X-rays: These help assess the effectiveness of breathing.
  • Bronchoscopy: A thin tube with a camera is inserted into the respiratory tract to view the inside of the lungs.
  • Modified Barium Swallow Test: The patient swallows liquids or solids containing barium, and a series of images are taken to check for leaks into the airway.
  • Fiberoptic Endoscopic Evaluation of Swallowing (FEES): A thin tube with a camera is inserted through the nose to view the throat and larynx while the patient swallows saliva or food. This helps detect any leakage into the airway.

Treatment

The primary aim of aspiration treatment is to address the underlying cause. Without resolving the root issue, eliminating aspiration completely may not be possible.

Some measures to prevent aspiration include:

  • Eating small bites of food
  • Remaining calm and relaxed while eating
  • Softening dry foods with sauces or liquids
  • Avoiding taking new bites before swallowing the previous one
  • Refraining from talking while eating or drinking
  • Avoiding eating or drinking while lying down
  • Maintaining good oral and dental hygiene
  • Avoiding smoking

Aspiration can lead to serious health problems in both adults and infants. To prevent these issues, necessary precautions should be taken during feeding. Individuals experiencing symptoms of aspiration should seek medical attention promptly. Stay healthy!