Aspiration is a medical term for accidentally inhaling your food or liquid through your vocal cords into your airway, instead of swallowing through your food pipe, or esophagus, and into your stomach. Once past the vocal folds, the food or drink enters your windpipe, or trachea, and can pass into your lungs. It happens sometimes to healthy people who have food “going down the wrong pipe” while swallowing. When this happens, a normal voice box, or larynx, and trachea sense the food or drink, which triggers a strong cough to clear the item from your windpipe and protect your lungs.

What Are the Symptoms of Aspiration?

When swallowing becomes difficult, or the sensation of your throat or voice box becomes impaired, anything that passes through your mouth can get into your lungs, even saliva, which is full of bacteria. Symptoms of aspiration may include:

  • Strong coughing
  • Choking while eating
  • Pneumonia
  • Trouble swallowing
  • Stress while eating
  • Weight loss

Again, aspiration is of great concern because it increases your risk of developing pneumonia.

What Causes Aspiration?

Aspiration can happen for many reasons and often should be looked at by an ENT (ear, nose, and throat) specialist, or otolaryngologist. If you have frequent coughing while eating or drinking, this is a sign you should see a doctor about swallowing problems. Given the possibility that aspiration might lead to pneumonia, finding it early is important. Sometimes when a stroke or other condition makes the vocal cords less sensitive, coughing may not be a signal that you are having difficulty swallowing, which can lead to silent aspiration.

What Are the Treatment Options?

Doctors often ask other healthcare providers such as speech-language pathologists (SLP) to help test swallowing problems. They may use a small camera placed through the nose to examine how food passes by the voice box into the esophagus during a swallow. Testing may also include a special X-ray video, called a modified barium swallow. This allows the SLP and doctor to watch the food pass through the entire swallowing activity from lips to esophagus. These tests may show what is wrong in the swallowing process, and help them figure out how to help you eat and drink safely.

Sometimes, simple diet changes are all that is needed to prevent aspiration. Other cases may need swallowing therapy. During therapy, exercises for swallowing strengthen and coordinate the muscles used in swallowing. Some swallowing problems may need surgery. Unfortunately, in certain situations, swallowing is so difficult or unsafe that a person cannot take in any food or drink by mouth. Then, interventions like a stomach feeding tube can supply food and fluids. In these situations, your doctor(s) and clinical team will work to help you find treatment(s) to regain a safe, effective swallow.

If you have any questions or concerns about suspected aspiration for you or a loved one, please find a nearby ENT specialist for consultation.

What Questions Should I Ask My Doctor?

  1. What is the difference between choking and aspiration?
  2. Do you know why I have difficulty swallowing?
  3. What are the tests for my swallowing problem?
  4. Did I get pneumonia from aspiration?
  5. What is the treatment for aspiration?
  6. What is the oral care regimen for people that aspirate?
  7. Do I need a feeding tube?
  8. What is swallowing therapy?

Copyright 2021. American Academy of Otolaryngology–Head and Neck Surgery Foundation. Last reviewed April 2020.

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