| 1. Specific clinical features |
- Known aspiration or history of dysphagia.
- Coughing, choking, frequent throat clearing, or wet-sounding voice during or immediately after meals.
- Shortness of breath during or shortly after meals.
- Prolonged chewing and/or reduced clearing of food from mouth.
- Complaints of food sticking in throat.
- Of note, not all patients who are aspirating will show signs of aspiration (eg, coughing), therefore silent aspiration needs to be considered. Patients at risk for this may have decreased sensation in the upper airway from tissue damage (eg, from prolonged intubation or radiation) or sensory loss (eg, stroke).
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| 2. Disease categories |
Oropharyngeal: - Cerebrovascular disease (eg, stroke, aneurysm)
- Degenerative neurologic/neuromuscular disease (eg, ALS, dementia, Parkinson disease)
- Head and neck cancer
- Cardiothoracic surgery
- Pulmonary disease
- Vocal fold dysfunction
- Critical illness dysfunction
- Frailty
- Polypharmacy
- Cervical spine surgery
Esophageal: - Esophageal dysmotility or stricture
- GERD/hiatal hernia
- Lower esophageal sphincter incompetence
- Achalasia
- Esophageal cancer
- Gastroparesis/ileus
- Postictal/perioperative
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| 3. Medical interventions |
- Artificial airway
- Mechanical ventilation
- Recent extubation following prolonged intubation
- Emergency intubation
- Self-extubation
- Noninvasive ventilation
- Enteral feeding
- NPO status
- Deep suctioning
- Perioperative period/general anesthesia
- Postbronchoscopy
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| 4. Patient characteristics |
Oropharyngeal: - Altered level of consciousness/Glasgow Coma Scale <9
- Excessive oral secretions
- Hoarse, weak, or wet-sounding voice
- Unstable pulmonary status; high oxygen needs
- Poor cough reflex
- Slurred or unintelligible speech
- History of frequent pneumonias
- Older adut
- Poor functional and nutritional status
- Ill-fitting dentures
Esophageal: - Reflux/heartburn
- History of dysphagia to solid foods rather than just to liquids
- Recurrent nausea/vomiting
- Pain on swallowing
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