Silent Aspiration

What is silent aspiration?

Silent aspiration is when you accidentally inhale food, liquid or other material into your trachea (windpipe or airway) and you don’t know it. Normally, when you eat or drink, nerves and muscles in your mouth and throat work together to keep food or liquids out of your airway and lungs. You also have a flap above your voice box called the epiglottis, which opens and closes. Your nerves, muscles and epiglottis work together to direct food and liquids to your stomach, and air to your lungs.

With silent aspiration, you might not cough or feel anything. Silent aspiration may happen with foods, drinks, saliva or stomach acid (from acid reflux).

How does silent aspiration affect my body?

You can occasionally aspirate a small amount of something and not develop serious problems. Most of the time, your body clears it out with coughing.

But if you have silent aspiration, you probably don’t know that it’s happening or how often. If you aspirate liquids regularly you can develop aspiration pneumonia, an infection in your lungs. Without treatment, aspiration pneumonia can be very serious.

What are the symptoms of silent aspiration?

People with silent aspiration may not have any symptoms. But if you do have symptoms, they can be different depending on your — or your child’s — age. Signs of silent aspiration in babies include:

• Fast breathing or holding their breath during feedings.
• Frequent low-grade fevers without an obvious cause or infections in their respiratory tract, especially their lungs.
• Refusing to feed or turning away from the bottle or breast.
• Wet-sounding voice or cry after feeding.

Older children and adults with silent aspiration may experience:

• Faster breathing while eating.
• Feeling like something is stuck in your throat.
• Food refusal in toddlers.
• Nasal congestion that goes away after eating.
• Noisy breathing or wheezing without an obvious cause.
• Wet-sounding voice due to phlegm (mucus) after eating.
• Frequent bouts of infections like bronchitis.

What causes silent aspiration?

There are many possible causes for silent aspiration. It may happen by accident without a clear reason. But it often affects people who have a condition that interferes with their swallowing, such as:

• Cleft lip or cleft palate.
• Dysphagia (difficulty swallowing) or vocal cord paralysis.
• Gastroesophageal reflux disease (GERD), which causes your stomach acid to flow upward into your throat. People with GERD may aspirate stomach acid without knowing it.
• Laryngomalacia, a condition that affects your baby’s voice box and may increase their risk of swallowing problems and GERD.
• Neurological (brain and nerve) problems, such as cerebral palsy, multiple sclerosis (MS), seizure disorders or a previous brain injury or stroke.
• A tube that goes down your throat, like a nasogastric (feeding) tube or a tracheostomy (breathing tube) because of other medical conditions.

Who is at risk of silent aspiration?

Silent aspiration can affect people of all ages, from babies to older adults. People who might have a higher risk of silent aspiration include:

• Infants: Babies can’t communicate when they’re choking or having trouble feeding, so silent aspiration is more difficult to spot. In addition, their liquid diet is easier to aspirate than solid food.
• People with chronic conditions or disabilities: Many conditions can affect your ability to swallow, like MS or epilepsy. Health conditions that impact your swallowing can increase your risk of silent aspiration.
• Older adults: Conditions like dementia and stroke are more common in older people, and can change how you swallow or whether you notice that you have aspirated something.

How is silent aspiration diagnosed?

Diagnosing silent aspiration usually starts with a physical exam that includes your nose, mouth and lungs, and a discussion about your health history. If your baby is having these types of symptoms, their provider will also begin with a similar examination.

If needed, your provider may order certain tests to see inside your throat and check how you’re swallowing. You or your baby might need:

• Chest X-ray: This is a painless test that takes pictures of your lungs and chest. A chest X-ray can detect pneumonia and show the structures inside your throat and airways.
• Fiber-optic endoscopic evaluation of swallowing (FEES): During this test, your provider guides a thin tube with a camera through your nose. This allows them to see your throat as you swallow. Sometimes you drink a special liquid first that makes your swallowing easier to see.
• Laryngoscopy: During a laryngoscopy, your provider looks in your throat using a thin tube with a camera attached.
• Upper GI series: Before this X-ray test, you drink a liquid (barium) that will show up on the X-ray. An upper GI series can show problems in your digestive tract that can lead to GERD.

How is silent aspiration treated?

Treating silent aspiration begins with treating the condition that’s causing it. For example:

• If you have GERD, your provider may prescribe medication to help stop stomach acid from backing up into your throat.
• If your baby has mild aspiration with feeding, your provider may suggest keeping your baby upright during feedings. An upright position may help your baby swallow breast milk or formula more easily.
• Babies that frequently aspirate their breast milk or formula may need a modified diet with thickened feeds. If severe, they may need a temporary feeding tube inserted in their nose or belly. Usually, providers can remove the tube when your baby is better able to swallow.
• Surgery to correct a cleft lip or palate can help a person with this condition swallow normally.

After treating the underlying cause, your provider may order follow-up tests to see if your swallowing ability has improved.

How can I prevent silent aspiration?

There’s no known way to prevent silent aspiration. You can help keep yourself or your baby healthy by seeing your provider for regular checkups. Bring up any concerns you have about your health or your baby’s health, even if they seem small. Your provider is there to help you prevent health problems and provide treatment when you need it.

What can I expect if I have silent aspiration?

In babies, silent aspiration may go away on its own as they grow. But if a specific health condition is causing your or your baby’s symptoms, finding that cause is the first step.

Proper treatment of the cause often cures silent aspiration and you can live a healthy life. Ask your provider if you need to follow up regularly to check on your progress.

When should I see my healthcare provider?

If your baby has symptoms of aspiration or you think they could have silent aspiration, contact their provider. You should also visit their provider as recommended for baby weight checks and well checks, which can show if your baby is getting enough nutrition.

If you have symptoms of GERD or a swallowing problem, make an appointment with your provider. Getting the proper tests and treatment for health conditions can help you avoid silent aspiration or other complications.

When should I go to the ER?

Seek emergency medical care if your baby:

• Has a blue skin color.
• Is struggling to breathe.
• Develops a fever above 100.4 degrees F (38 degrees C) if your baby is less than 3 months old or above 102.2 degrees F (39 degrees C) if your child is between 3 months and 3 years old.
• Is hard to wake up from sleep.

You should also seek emergency care for yourself if you:

• Can’t swallow normally.
• Feel short of breath or like you can’t breathe.
• Have chest pain.
• Think food or an object is stuck in your throat or airway.

A note from Cleveland Clinic

Silent aspiration can be frightening, especially if it affects your baby. The good news is that treatment for the underlying cause can control or cure silent aspiration. Babies sometimes grow out of it as their nerves and muscles continue to develop and learn to work together. Whatever the cause, your provider is here to help you get the testing and treatment you need. Talk to them about your concerns, and together, you can develop a plan that helps you or your baby live a healthy life.