Tests for Aspiration Syndromes

Aspiration is when food, saliva or fluids enter the trachea (wind pipe) instead of the esophagus (food pipe). This can be directly from above while swallowing or can be from below when stomach contents come back in the throat and are aspirated. This can lead to bacterial infection of the lung also known as aspiration pneumonia. Pediatric pulmonologists ask for the following tests in children suspected to have aspiration after clinical assessment.

1. Chest Xray or CT scan of chest

Radiological imaging of the lungs gives valuable information about pneumonia to a doctor. Specific findings on CT chest point towards ongoing aspiration and helps in diagnosis.

2. Videofluroscopic Swallow Study (VFSS)

VFSS is another radiological test in which a medicine is mixed in the baby’s milk and fed while images are taken under fluoroscope. This medicine makes the passage of the milk visible. In children with aspiration, spillage of milk into the trachea or reflux of stomach contents into the throat can be visualized by this technique. This test involves some exposure to X-rays and is thus advised only if necessary.

3. Fibreoptic Endoscopic Evaluation of Swallowing (FEES)

This test is done using a bronchoscope which is a device used by pulmonologists to visualize the airway. It consists of a long tube with a camera fixed at its tip. In this test the bronchoscope is passed inside the nose and placed in the pharynx so that the opening of the trachea (wind pipe) can be seen. The child is then given milk and the passage of milk through the pharynx into the esophagus is visualized. This test gives real time visualization of the muscles of swallowing in the throat and in case of aspiration, milk is seen to pass into the trachea. This test is confirmatory for aspiration. Sometimes a dye may also need to be given to check for aspiration.

Where can I get these tests done?

FEES is performed by a trained pediatric pulmonologist in a bronchoscopy suite. Dr Ritika Goyal has expertise in performing FEES and analyzing VFSS in babies and in older children.