Cough and Aspiration of Food and Liquids Due to Oral Pharyngeal Dysphagia
Oral pharyngeal dysphagia should be included in the differential diagnosis of patients with cough. Aspiration of food and liquid below the level of the true vocal folds observed on dynamic imaging studies i.e., videofluoroscopic (VSE) and endoscopic (FEES) evaluations of swallow, has been associated with pneumonia. Coughing while eating and drinking may indicate aspiration; however, aspiration may be clinically silent. Subjective patient, caregiver, and nurse reports of reflexive cough while eating are useful but limited in identifying patients who are at risk for aspiration. Objective measures of voluntary cough are under investigation to determine their capacity to predict the risk for aspiration and subsequent pneumonia. The treatment of dysphagic patients by a multidisciplinary team, including early evaluation by a speech-language pathologist, is associated with improved outcomes. Effective clinical interventions such as the use of compensatory swallowing strategies and the alteration of food consistencies should be based on the results of instrumental swallowing studies. Reflexive cough while eating and drinking is important for the detection of oral pharyngeal dysphagia and objective measure of voluntary cough may be a good screening tool for this condition.
KeywordsAspiration Deglutition Reflexive cough Silent aspiration Speech-language pathologist Voluntary cough
- 7.Logemann JA (1986) Evaluation and treatment of swallowing disorders. College Hill Press, San DiegoGoogle Scholar
- 15.Agency for Health Care Policy and Research (1999) Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients: evidence report/technology assessment, No. 8. Washington, DC: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, AHCPR Publ. No. 99–E0249Google Scholar
- 22.Smith Hammond CA, Ying J, Horner RD, Goldstein LB, Gray L, Gonzalez-Rothi L, Bolser DC (2006) Comparison between reflexive cough after water swallow to aerodynamic measures of voluntary cough to identify patients with stroke-related dysphagia at risk of aspiration. Poster presented at the Department of Veterans Affairs Health Services Research & Development Meeting: Managing Recovery and Health through the Continuum of Care, Arlington, VAGoogle Scholar