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What is silent aspiration?

12 answers | Last updated: Apr 05, 2015
An anonymous caregiver asked...

What is silent aspiration?


Caring.com User - Jennifer Serafin, N.P.
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Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.
48% helpful

Silent aspiration occurs in people that have swallowing problems, which is known as dysphagia. Aspiration is when food, liquids, or stomach contents are swallowed poorly, and go into the lungs See also:
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by mistake. Usually when this happens, normal healthy people will turn red and start to cough, as an attempt to get it out of the lungs (think about yourself, when "something goes down the wrong pipe"). However, as people get weak and swallowing worsens, this aspiration can happen silently, which means there will be no signs showing that this has occurred. In other words, you will not see any coughing, choking, or turning red.

Aspiration is dangerous because the food/liquids/stomach contents enter into the lungs, which is very irritating. It can develop into an aspiration pneumonia, which is very hard to treat, even with multiple antibiotics.


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50% helpful
LouJ77 answered...

Thank you for this explanation! I think it will certainly help many people and might even encourage them to go for simple "swallow tests". I Have just been throught this with my 92 year old mother who suffered a bleeding stroke and then a seizure last week. She has been coughing when eating in recent months. I suspected it was mostly when drinking, however, instead of eating. At the hopstial she has had "swallow tests". They explained to us that liquid that pours like water doesn't stick together and sometimes "splashes" "down the wrong pipe" - aspiration. The solution for Mother has been to "thicken" liquids. The speech therapist explained that when the liquid is thicker than water, it sticks together as it is swallowed so that it will no longer go down the wrong pipe. This has helped Mother tremendously. It's my understanding that with some illnesses, patients can "forget" how to chew and swallow. This isn't the case for my mother, so thickening the liquids to about buttermilk consistency has been the answer for her. It's been so much easier on her to be able to enjoy her meals and liquids instead of being exhausted from coughing becuase of them!


40% helpful
anngw answered...

I wish that I had known this for my husband. The doctors were not helpful. He died from aspiration pneumonia at age 59.


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jacky33 answered...

my 74 old hubby has silent attacts too, also many hours of caughing. has had speech therpy, now machine stimals nothing is working, talk of feeding tubs, he rejects that idea totaly; he keeps getting double phemunia, 3 times in 5 months; he has so much wrong, shocked made it this long. DR`S are in awa, cat of 12 lives & counting

needs thickit to his drinks, is there flavored thicket out there? god bless


43% helpful
seekersusie answered...

Flavored Thickit: if there was flavored, it would probably be due to synthetic chemicals, which stresses the body, especially when its most vulnerable due to illness and being elderly. I would opt for natural whenever possible; less likely to complicate things. Use fresh lemon or orange juice to flavor water for instance. Remember, flavor is often difficult to find for the elderly, so, in my experience using higher concentration of natural foods, paired, when appropriate, with herbs: healthier and more flavor, less sodium needed for taste.


ErickaGoodnight answered...

I have been dealing with silent aspiration since my son was a month old. It took me 3 months to get a doctor to order a swallow study. At 4 months old he was put on honey thickened liquids. We do a swallow study every 6 months. He has been on nectar thick liquids since he was 10 months old, he is now almost 2 1/2. We go for the next swallw study on the 18th and I pray he passes it this time. I think my biggest fear is him having to go to school and thicken his own drinks. I would hate for him to be teased because of something he can't control.


An anonymous caregiver answered...

As a Speech/Language PAahologist, I can attest to the suffering patients endure when swallowing distress symptoms occur. While there are pre-packaged, thickened liqs. available , as well as some canned foods at prescribed consistencies, the care giver and patient both must consider the need for constant/committed use of these textures in foods/liquids. I tell patients,"Pretend the patient has a blindfold". When eating or drinking, the body can only react to the consistencies taken in, not to the exact food/drink consumed. This means that while one would think, "Oh, it's OK to have a soda not thickened once in a while", that is not so. Once prescribed, it is forever unless via therapeutic interventions or nature's kindness the condition resolves. Why take a chance on the possible event of getting a very serious pneumonia and or choking/stopping air exchange? That one chance in a few, could require heavy antibiotics building up a resistance to future use, or spell a terminal diagnosis. Even though some protocols, such as the "Frasier Free Water" theory exists, allowing once in a while thin water, it is that chance that might be the fatal one. Why risk it? Get either a FEES test or Modified Barium Swallow, per MD order to actually show you what is going on in your swallowing disturbamce, if you want to make a clear judgement.Silent aspiration is best determined by these tests and could save a life!


AllTexas answered...

I am going through this right now with my 92 year old father. We did the swallow test and had 21 sessions of speech therapy with the vital stem applied. He was able to do everything the therapist asked. No problem. The therapist commented on occasion that he thought we were making real progress. We did another swallow test today, and found that absolutely nothing had changed. At this point I don't know if more therapy would do anything or just live with it. Up to this point he hasn't had any pneumonia. I keep a close watch for him. He suffers from year around allergies.


100% helpful
LillyBritches answered...

i'm sorry, but none of you has REALLY addressed and defined silent (salivary) aspiration. What you're describing in the answers is plain ol' aspiration, not SILENT aspiration. Silent aspiration occurs when someone is aspirating on his or her saliva, either during sleep or during the course of dementia/parkinson's/parkinsonism. In other words, over a gradual period of time as the disease progresses. There is absolutely nothing to do for "silent" aspiration, other than be aware and watch for signs that pneumonia has developed. You can't insert a 24-hour suction. My 93-year-old mom has just been DXed with silent aspiration - classic signs - I already thicken her water and she's on a mechanical soft diet with most of her foods either pureed or chopped up very, very finely. She has been developing something called "pneumocystis" - which isn't a pneumonia - rather, it's an inflammatory response to silent aspiration that presents with spiking low-grade fevers and lower O2 saturation (lower than baseline) which resolves in a couple of hours. Of course, pneumocystis leaves the lungs very vulnerable to pneumonia.

When these little low-grade fever spkes occur, all you can do is increase someone's O2 levels slightly if they're on oxygen, and watch and make sure that the person isn't developing a high-grade fever as well as coughing, coughing up blood, sputum, etc. Then you must seek treatment immediately, because that could be indicative of a bacterial pneumonia developing.


An anonymous caregiver answered...

Lilly.......you are so right. My daughter aged 38 (Down's syndome) was treated for pneumonia on and off for years. 8 years ago she was diagnosed as having silent aspiration put on NUTILIS thickner which can be added to most drinks any flavor beverage bovril juices soups also in her pureed/liquified food too. Oxygen keeps her levels up as she is only 80-88 on air, she still gets a few infections as saliva is now the problem when she lays down so loads of pillows sleeps sitting up is best. Although no one has monitored her swallow since being diagnosed 8years ago I do think its left to family to manage keeping them alive. But then it is the NHS !!!


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An anonymous caregiver answered...

My husband just passed away from ALS and he was having silent aspiration. The day he passed I had given him some thicken flavored water and some scrambled eggs and he started chocking on his saliva in his throat but his cough was too weak to cough it up. I had a cough assist machine but no suction. Evidently we did not get it all because about an hour after that he started having breathing problems and his blood oxygen went down to 50. We called the paramedics and they took him to the hospital which is two blocks from our house. Within 15 minutes I had to make the decision to vent him or let him go. He did not want to be vented so I had to let him go. So this can be a very serious situation depending on the circumstances. He had just had the swallowing test 4 days prior.