Introduction
Aspiration, which is the diversion of the oropharyngeal secretions or gastric contents into the throat and lower respiratory system, is common in adults with dysphagia and can lead to aspiration pneumonia. In point of fact, people who suffer from dysphagia have a significantly higher risk of developing pneumonia. Malnutrition and dehydration are two more negative outcomes that can result from dysphagia. In hospitalized patients who have dementia, dysphagia is a major predictor of unfavorable clinical outcomes.
What Is the Physiological Process That Occurs When One Ingests Substances Through the Act of Swallowing?
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After ingestion, food passes from the oral cavity to the pharynx.
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Subsequently, the ingested food passes down a lengthy body part known as the esophagus, ultimately reaching the gastric part of the digestive system.
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The facilitation of this travel is enabled through a sequence of muscular activities in these regions.
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The pharynx is an integral component of the respiratory system responsible for facilitating the passage of air into the lungs.
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During the process of respiration, atmospheric air is drawn into the oral cavity and then passes into the throat.
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Subsequently, the inhaled air descends into the primary airway, known as the trachea, and proceeds to enter the pulmonary organs, namely the lungs.
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The epiglottis, a piece of tissue, is positioned superiorly to the larynx, also known as the vocal cords. The purpose of this anatomical structure is to prevent the passage of food and liquid into the trachea during the act of swallowing.
Who Is More Likely to Experience an Aspiration Event Due to Dysphagia?
Aspiration is always a possibility for a person who suffers from dysphagia. If one suffers from any of the following medical problems, then one may be at an increased risk of aspiration due to dysphagia:
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Ischemic attack.
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Extreme difficulties with teeth.
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Conditions such as Sjogren syndrome (an immune system condition distinguished by the two most common symptoms, dry eyes, and a dry mouth) result in decreased saliva production.
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Ulcers of the mouth.
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Parkinson's disease (a neurological condition characterized by involuntary or uncontrolled movement disturbances, including tremors, rigidity, and impaired balance and coordination.) and other disorders affecting the nervous system.
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Dystrophy (the causes and effects of inherited changes that happen slowly to specific cells in one or more tissues that work normally initially).
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A blockage in the esophagus is caused by something like a tumor caused by cancer.
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Acid reflux.
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A history of getting treatment for cancer of the throat or neck with radiation or chemotherapy.
What Are the Symptoms?
Some persons who have aspirations do not have any symptoms at all. This is referred to as "silent aspiration." Symptoms associated with aspiration include the following:
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Having the sensation of food becoming lodged in one’s throat or continually returning to the mouth.
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Experiencing discomfort while trying to swallow.
Issues getting started with the swallow would include:
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Experiencing coughing or wheezing either after or while eating.
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Discomfort in the chest or heartburn.
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Fever between thirty minutes to one hour after eating.
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An excess of salivation.
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Having congestion in the chest after eating or drinking.
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A voice that sounds as though it is dripping with moisture before, during, or after eating or drinking.
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Experiencing difficulty breathing or fatigue while eating.
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Expelling blood from their mouths.
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Pneumonia manifests itself over and over again.
The onset of symptoms may coincide with eating, or they could develop gradually over time. It is possible that not all of these symptoms are present in a patient. They may depend on the frequency of aspiration as well as the amount of food or liquid the patient consumes.
What Is the Diagnostic Method?
If individuals exhibit symptoms, it is necessary to have an evaluation for aspiration resulting from dysphagia.
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Medical History - It may be necessary to have a medical evaluation to ascertain the presence of a stroke or any other underlying health condition that may contribute to dysphagia. In the event that a healthcare provider suspects the possibility of aspiration, patients may get instructions to abstain from consuming food or beverages until undergoing diagnostic testing.
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Physical Examination - The healthcare provider will inquire about the patient's medical history and present symptoms. This task can be performed by a professional known as a speech-language pathologist (SLP). The speech-language pathologist (SLP) will endeavor to ascertain whether there are any impairments in the musculature involved in the lower or upper regions of the patient's swallowing mechanism. The speech-language pathologist (SLP) may inquire about the specific food items or beverages that elicit adverse reactions, as well as the temporal occurrence of symptoms.
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Oral Examination - It encompasses an examination of the dental structures, oral mucosa, maxillofacial structures, lingual region, and buccal region. Participants may be instructed to manipulate these regions in specific manners and produce designated auditory stimuli. The speech-language pathologist (SLP) may also conduct assessments to evaluate the individual's ability to swallow various consistencies of liquids and solids. It may be necessary to undergo additional testing, which may include one or more of the following. These methods can aid in identifying the etiology of dysphagia. Tests are frequently beneficial in detecting instances of silent aspiration. The examination may encompass the following components:
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The Modified Barium Swallow Test (MBS) - This procedure is conducted to assess the presence of material entering the pulmonary system and to identify any potential abnormalities along the oropharyngeal swallowing pathway.
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Fiber-Optic Endoscopic Assessment of Swallowing - The technique known as fiber-optic endoscopic assessment of swallowing (FEES) is employed for the purpose of assessing swallowing function. This examination can also provide insights into the presence of material entering the pulmonary system and the morphological characteristics of the pharyngeal structures during and post-deglutition.
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Pharyngeal Manometry- This examination assesses the pressure levels within the pharynx and esophagus.
What Measures Can One Take to Reduce the Risk of Aspiration Due to Dysphagia?
The following actions can help lower the risk of aspiration:
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Maintaining a healthy mouth and set of teeth is very important.
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Receiving dental care (including dentures) when it is required.
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Taking medicine in the prescribed manner.
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Cessation of smoking.
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Maintaining correct posture while in the act of eating or drinking.
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Performing oral exercises in accordance with the recommendations of the SLP.
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Making adjustments to the diet in accordance with the recommendations of the SLP.
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Contact the healthcare practitioner for additional recommendations on how to avoid experiencing an episode of aspiration in an instance.
What Are the Preventive Methods?
A single remedy almost never suffices on its own to thwart or lessen the effects of ambition.
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Direct Interventions - For patients suffering from dysphagia, an interprofessional group provides a comprehensive prevention strategy. Direct interventions typically take place during the process of eating and include modifying diet as well as adopting a chin-tuck or chin-down posture, which is relatively simple and quick to put into practice. However, they are not a long-term solution to the problem.
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Indirect Interventions - The rehabilitation programs that concentrate on exercising particular muscles or muscle groups, stimulation treatment, and pharmacological treatment can reduce aspiration by improving swallowing function. However, they typically require a considerable amount of time before showing any noticeable results, and they cannot be utilized independently in the absence of direct interaction. It has also been suggested that oral care can help prevent aspiration pneumonia as an indirect form of intervention.
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Interdisciplinary Interventions - The interdisciplinary team often included some or all of the following professionals: speech and language therapists, medical doctors, dental surgeons, registered nurses, certified nursing assistants, care workers, social workers, dietitians, chefs, and catering managers. The interdisciplinary approach is an adjunctive intervention that ought to be provided to all elderly persons. In the management of aspirations, interdisciplinary interventions have proven to be of great benefit.
Conclusion
Aspiration, which is the diversion of the oropharyngeal secretions or gastric contents into the throat and lower respiratory system, is common in adults with dysphagia and can lead to aspiration pneumonia. In point of fact, people who suffer from dysphagia have a significantly higher risk of developing pneumonia. Malnutrition and dehydration are two more negative outcomes that can result from dysphagia. Proper intervention and therapy would have a lower impact on the condition.
