Videofluoroscopic Swallowing Study (VFSS)

This is an examination that looks at the function, structure, and movement of the organs used for swallowing, and the causes of any swallowing disorders. The procedure involves the patient swallowing a white powder called barium sulfate, followed by X-rays to determine any abnormalities in the oral, pharyngeal, and esophageal phases of swallowing. The examination is performed in the X-ray room by a team of medical professionals that includes doctors, nurses, occupational therapists, and radiologists.  During the test, a small amount of barium is mixed with foods and drinks of varying amounts, thickness, texture, and other characteristics to assess the patient’s swallowing and any physiological abnormalities, as well as to determine appropriate treatment options. In addition, certain special swallowing techniques and posture modifications may also be applied during the assessment. One limitation is that pharyngeal secretions cannot be assessed prior to swallowing.

Recommendations After Examination

• The patient can resume their usual diet.
• After the exam is completed, the occupational therapist will help to clean the patient’s mouth, as barium sulfate can get stuck between teeth, gums and cheeks.  
• In the case of any constipation or difficulty in passing stools, the doctor may provide the patient with a laxative that can be taken before bed to help with bowel movements. Normally, however, the barium sulfate is able to leave the body during bowel movements over the course of 1-2 days and is not absorbed by, or left inside, the body.   

Videoendoscopic Swallowing Study (VESS)

A videoendoscopic swallowing study of the upper gastrointestinal tract can be carried out either in an examination room or, for inpatients, in the patient’s own hospital room. For this procedure, the doctor will use a nasolaryngoscope, which looks like a small, flexible tube with a tiny camera and light at the end of it. The nasolaryngoscope is inserted through the nose and into the esophagus and, due to its flexibility, can be adjusted to bend in the desired direction. Images recorded by the camera are displayed on a screen so that the doctor can see if there are any abnormalities in swallowing functions and/or tissue structures in the pharynx and larynx. With this test, patients do not need an X-ray, making it suitable for patients who are unable to undergo assessment using barium. This test has limitations: it cannot be used to assess the oral or esophageal phases of swallowing.  

Recommendations After Examination

• The patient may feel unwell or feel like they want to vomit.
• For safety purposes, the patient should have relatives or friends help to bring them to the hospital and to pick them up after the examination. In order to ensure that treatment is regular and effective, the patient should receive examination and treatment according to the doctor’s recommended schedule.  

Preparation and Examination Procedure

The patient should make sure to tell their doctor about any underlying diseases, history of drug/chemical allergies, any medications they take regularly, and surgical history, if any. The patient should get enough sleep and may need to refrain from taking certain drugs prior to the examination, depending on their individual symptoms. Some patients may need to abstain from any food or water, although this is dependent on their doctor’s advice. The patient should arrive at the hospital 30 minutes prior to their appointment in order to prepare for the procedure.  Patients undergoing the videofluoroscopic swallowing study should make sure to wear clothing without any metal attached that is convenient to change in and out of. 

Indications

A doctor will recommend testing by videofluoroscopic or videoendoscopic swallowing study for patients with dysphagia or with any of the following associated disorders:  

• Coughing or choking while eating/drinking
• A “gurgly” wet sounding voice or a “wet/hoarse” voice quality
• Wheezing, shortness of breath, or a change in breathing during or after eating/drinking
• A history of frequent respiratory infections
• Patients diagnosed with, or suspected of having, aspiration pneumonia
• Neuromuscular diseases that affect swallowing   

Occupational Therapy for Patients with Dysphagia  

After a Physical Medicine and Rehabilitation (PM&R) doctor has referred the patient to an Occupational Therapist, the Occupational Therapist will then conduct an assessment in order to make a treatment plan, adjust the patient’s diet, and recommend various techniques, including posture and positioning while eating, to help the dysphagia patient improve their quality of life.  

Primary Dysphagia Treatment Guidelines  

1. Positioning while swallowing: The patient should sit upright at a 90-degree angle, with their feet flat on the floor. They should never tilt their head back. Reducing external stimuli, such as turning off the television, can also help elderly patients focus better on eating and reduce the risk of choking.
2. Dietary adjustments: In order to make food more suitable for the elderly, it should be cooked to soften it, making it easy to chew and digest. Food should be plated so that it is colorful and appetizing, and should be cooked fresh for each meal.   
3. Exercising muscles used in swallowing: These include the muscles in the lips, tongue, cheeks, and jaw.
4. Special swallowing techniques: Techniques intended to improve safety and/or efficiency while swallowing include the Shaker exercise, the Masako Maneuver, effortful swallow, super-supraglottic swallow, etc. The selection of technique will depend on the particular defect in the swallowing mechanism of each individual patient and, as such, will require specific assessment by a physician and an occupational therapist.