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Silent Aspiration — SCE Neurology MCQ

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ModerateNeurorehabilitationSilent AspirationSCE Neurology

A post-stroke patient passes an initial bedside water-swallow screen but has recurrent wet voice, coughing with medication and two chest infections in the following week. What is the most appropriate next swallowing assessment?

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Correct answer: C — Urgent speech-and-language assessment with instrumental swallowing assessment such as FEES or videofluoroscopy if indicated

A bedside screen can miss aspiration, including silent aspiration. Persistent clinical concern after stroke requires prompt specialist swallowing assessment and, where uncertainty remains, instrumental assessment with FEES or videofluoroscopy to define physiology and guide safe nutrition, fluids and rehabilitation. Reassurance from the initial screen or repeated empirical antibiotic treatment risks recurrent aspiration injury.

Reference: National Clinical Guideline for Stroke, swallowing and nutrition: https://www.strokeguideline.org/chapter/motor-recovery-and-physical-effects-of-stroke/