Modified Monday: Normalizing the Swallow - Everyone Aspirates
Updated: Dec 19, 2022
A few years ago, I was taking a look how different barium shows up on our swallow studies to compare it to Varibar. I was talking to the physician I was working with, trying to chug thin liquid and watch myself on fluoro all at the same time… and I aspirated. I was pretty excited about it after, since I had a pretty good video clip of a normal healthy person aspirating, but in the moment I just couldn’t get over my embarrassment. What got me through it was the realization that EVERYONE aspirates. We get so used to thinking it is a sign of impairment, something to be prevented at all costs… that we forget that it can be really, really NORMAL.
In studies completed with FEES in 2009 and 2011, Susan Butler et al found that of the normal, healthy individuals assessed, around a third of them aspirated. Just looking at whether a person aspirates or not does not give us good data on that person’s swallow. It is really important to look at the cause and the frequency of the aspiration, the response to the aspiration, as well as the conditions under which it occurred (keep an eye out for an upcoming Modified Monday on how different ways of presenting a bolus can impact the swallow).
In the Butler studies, the aspirations accounted for 3% of the total swallows, so a very small incidence rate comparatively. As with everything in swallowing and dysphagia, we MUST look at the whole picture, not just one isolated part of the picture. Here is my lovely aspiration clip, I am very comfortable sharing now, since I know I’m just a normal gal. (Check out the third article below, in which the Butler et all team followed up with the aspirators from the first study and found that they were still aspirating 12 months later-further evidence that aspiration can be considered a normal variant in some cases. Again, the big picture is crucial to making good recommendations!!)
https://journals.sagepub.com/doi/abs/10.1177/000348940911800306
https://academic.oup.com/biomedgerontology/article/66A/4/452/687896?login=true