The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as "red-flag" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.
Tess Sierzant, MS RN CNS-BC CNRN, is a neuroscience clinical nurse specialist at the HealthEast Saint Joseph's Hospital, National Brain Aneurysm Center, Saint Paul, MN.
Charles Ormiston, MD, is a neurologist at the HealthEast Saint Joseph's Hospital, National Brain Aneurysm Center, Saint Paul, MN.
Questions or comments about this article may be directed to Bernard R. Garon, MS CCC-SLP, at firstname.lastname@example.org. He is a senior speech pathologist at the HealthEast Saint Joseph's Hospital, Department of Physical Medicine, Saint Paul, MN.