Fiberoptic endoscopic evaluation of swallowing as a diagnostic tool in infant silent aspiration

Abstract

<b>Introduction:</b> Chronic lung aspiration is not that uncommon in infancy, resulting in chronic or recurrent respiratory symptoms. Occasionally aspiration can be silent, without acute reflexive cough or any other sign of distress. Fiberoptic endoscopic evaluation of swallowing (FEES) is an alternative to videofluoroscopy swallow study (VFSS), with no barium or radiation. We aimed to present our experience as a pragmatic study on the clinical utility of FEES in infants with persistent respiratory symptoms. <b>Methods:</b> Infants presented with chronic/recurrent wet cough and/or noisy breathing in our clinic during the period 2013-2017, were examined for silent aspiration. Subjects with other diagnoses such as neurologic disorders, prematurity, genetic disorders, tonsillar hypertrophy, structural airway abnormalities or symptomatology suggestive of gastroesophageal reflux disease were excluded. Aspiration was investigated with fiberoptic endoscopic evaluation of swallowing (FEES), during milk formula consumption. <b>Results:</b> All together 19 infants (M/F 11/8) were examined for silent aspiration with FEES. The median age of evaluation was 4.2 months (range 1-10.5 months). The test showed profound deep larynx penetration and/or aspiration of milk formula in 6 infants (31.6%) (1-5 month-old) (p= 0.008), establishing the diagnosis of silent aspiration. <b>Conclusion:</b> Silent aspiration is a quite common contributing factor in infants with chronic/recurrent wet cough and/or noisy breathing and can be easily detected with FEES. This may help to avoid more complex and unnecessary or expensive examinations.cv