In normal anatomy, the epiglottis and proper vocal cord function prevent food or liquid from entering the lungs during swallowing. However, when a laryngeal cleft is present, substances (food, liquid, saliva) may leak through the gap and enter the trachea. This is called aspiration, and it causes most of the symptoms seen in children born with a laryngeal cleft.
Typically when aspiration occurs, the body responds by coughing to clear the lungs and trachea. When a child coughs after aspiration, it may not result in damage to the lungs. However, if the child does not respond by coughing, aspirated substances may enter the lungs and eventually cause damage.
Aspiration
In infants, the coughing reflex usually develops in the first few months, but may be delayed. Infants that have not yet developed this coughing reflex may experience silent aspiration without the typical cough. Signs of silent aspiration during feeding include:
Silent aspiration
stridor while feeding
watery eyes
excessive drooling
apnea (pause in breathing)
bradycardia (low heart rate)
Microaspiration
Microaspiration is when tiny amounts of food, drink, reflux, or secretions are aspirated into the lungs. If microaspiration continues over months and years, it can gradually result in symptoms such as hoarseness, stridor, long-term cough, wheezing, and more.
Any aspiration needs to be promptly evaluated, ideally by a team of experts that includes at least an otolaryngologist (ENT), pulmonologist, gastroenterologist, and speech-language pathologist. Chronic aspiration can lead to recurrent respiratory tract infections, hospitalizations, supplemental oxygen needs, lung damage, and even respiratory failure and death.