Aspiration is the abnormal entry of food or liquid into the windpipe and subsequently into the lungs. Aspiration is important because it may lead to the development of pneumonia and/or long term lung complications. Normally, food and liquid are diverted around the breathing passages and directed into the esophagus. In certain disease processes, however, these mechanisms do not function normally, and aspiration occurs.

Aspiration may be detectable as a cough or gagging associated with food or liquid intake, or it may have no associated symptoms. So-called “silent aspiration” is troublesome, because if is very difficult to detect.

Diagnosis of aspiration may require special testing. There are several different types of tests that are available. These are: barium swallow test, videofluoroscopic swallow study (VFSS), and flexible endoscopic evaluation of swallowing (FEES). Each type of study has its advantages and disadvantages. A specific test is chosen based on the characteristics of the patient and the suspected diagnosis. Oftentimes, tests may have to be combined to make a proper diagnosis.

A barium swallow test if the least sensitive of the tests for aspiration. It is primarily useful for screening patients for certain abnormalities, including tracheoesophageal fistula and Zenker’s diverticulum. This test does involve the use of x-rays, and which may limit its use in certain patients.

A VFSS gives valuable information on the patient’s ability to tolerate different textures of food and liquid, and is excellent in examining the upper esophagus. However, it does not give good anatomic information, so that subtle abnormalities may be missed. In addition, like the barium swallow study, it does involve the use of x-rays.

As opposed to the VFSS, a FEES study gives excellent anatomic information, including assessment of the voice box. However, this study is not able to examine the upper esophagus directly.

Treatment of aspiration is based on the findings of the above-mentioned studies. Certain modifications may be recommended to prevent aspiration. These may include dietary changes or adjustments in head position while eating. If there is evidence of severe aspiration, which puts the patient at higher risk for development of pneumonia, it may be recommended that the patient avoid eating altogether. In this case, alternate means of nutrition are employed. However, most cases are not severe and patients may be able to avoid aspiration by adjusting their diets and the way in which they eat. Certain patients may require therapy or surgery to improve their swallowing mechanism, with the goal being to eventually restore them to a normal diet.