Modified Mondays: The Sound of Silence*

*Sincerest apologies if you were expecting Simon & Garfunkel (or Disturbed, depending on your age bracket.)

If you need a great example of silent aspiration to “prove” it’s existence to nursing (or other interested parties), this is it. This patient had been progressively upgraded, citing “no overt s/s aspiration” but with recurrent pneumonia and infiltrates, so an MBS was finally ordered. Make sure you turn the sound on, as you can hear not only our CLE market SLP Angela commenting on the consistencies presented, but also the patient talking, and asking about the cookie flavor, all while a large amount of the bolus sits in the airway and on the vocal folds.

We have all heard the numbers a million times… around half of aspirators are silent aspirators, and SLPs only correctly identify aspiration clinically (at bedside) around half the time. This is also a great example of why listening for “wet” vocal quality is not a reliable indicator, since this fella’s voice doesn’t really change with the introduction of all that bolus into the airway. Check below for more reading:

https://pubmed.ncbi.nlm.nih.gov/19678503/

https://www.researchgate.net/publication/7407130_Silent_Aspiration_What_Do_We_Know