Wednesday, September 13, 2006

Huh? Where'd That Come From?

I came across a short article the other day, written by a speech pathologist. At one point the author listed signs of aspiration: "Coughing, throat clearing, wet 'gurgly' voice, respiration changes, watery eyes and nose, and widening of the eyes are all indicators of aspiration." Okay, the coughing, throat clearing, gurgly voice, and respiration changes I agree with. The watery eyes and nose, if bilateral and accompanied by a cough. (Unilateral eye tearing or nose running is something else entirely. It MAY be associated with deficits which can cause aspiration, but is not a sign of aspiration in and of itself.)

But the last one in the list? "Widening of the eyes"? Where on earth did that come from? I have never heard that one before as a sign of aspiration. I don't even see how that could even be related. Unless, of course, it's part of the shocked/panicked expression a person gets when they realize they're choking... (but even then, it would hardly be the most salient detail -- the sudden apnea, cyanosis, inability to speak, and possible collapse would probably be slightly more obvious symptoms in such a situation, don‘t you think?!)

Huh. Well, either the canonical “Signs/symptoms of aspiration” list expanded when I wasn’t looking, or else the Dysphagia Myth Generator has been working overtime. (I’m guessing the latter).


Blogger Deb said...

Hi Speechy Keen,
I know this is an old blog post, but I just read it today and thought I'd contribute my "two cents" anyway. I'm a Speech pathologist working in the sub-acute rehabilitation and long-term care settings. I have had several experiences with the "widening of the eyes" referenced in your post. These experiences all involved long-term care residents with dementia. Typically the residents were demonstrating signs of dysphagia such as recent diagnosis of pneumonia and/or caregiver observations of changes in eating/swallowing behavior. During my bedside evaluations of these residents, I would typically see a widening of the eyes or a panicked expression immediately following the swallow, but no overt symptoms such as cough. In these cases, it was obvious to me that something was "going wrong" with the swallow, but because of the residents' dementia they could not tell me what they were experiencing. After the first two cases were found on subsequent instrumental evals (MBS or FEES) to be silently aspirating, I became much more alert to this "widening of the eyes" in residents with dementia. Although it's certainly not a measurable symptom, it is still one that SLPs, particularly those working with dementia patients, should be aware of.
Debspeak, SLP in Connecticut

3:09 PM  

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