The SLP checks for signs of dysphagia and aspiration throughout the exam. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. [Google Scholar] Multiple studies have demonstrated that there are higher rates of aspiration when patients have inflated tracheostomy cuffs versus deflated. A swallowing study including a modified barium swallow study or a flexible endoscopic evaluation of swallowing may be performed to confirm the diagnosis of aspiration. These authors concluded that the MEBDT should “be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.” A new technique that I developed known as FEESST or Flexible Endoscopic Evaluation of Swallowing with Sensory Testing, is the first swallowing test to do both. 11-14 In instances when cuffs are overly inflated, swallowing has been shown to be difficult to elicit and slower. The MEBDT identified aspiration in 67% of patients who aspirated more than trace amounts, but failed to identify aspiration in trace amounts. There is little agreement on the threshold for desaturation with swallowing that would reliably identify aspiration risk: cutoff values ranging from 2% to 4% have been suggested by different authors. Barium swallow test helps clinicians to identify the reasons for swallowing problems and to determine if there are ways to keep swallowing safe. This test helps the SLP see what happens in your mouth and throat when you swallow. All types of swallowing testing, including endoscopic tests and x-ray tests of swallowing, look at how things move. About the VFSS . An SLP or a qualified clinician most often does the bedside swallow exam. Oxygen saturation measurements were taken before the videofluoroscopic examination (baseline), on swallowing and continuously for 2 minutes after swallowing, and 10 minutes later. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration. Researchers from the University of Auckland say the odds of dysphagia multiply with longer intubation, rising to 67% prevalence after more than 48 hours of intubation. Detection of aspiration and swallowing disorder in older stroke patiens: simple swallowing provovation test versus water swallowing test. However, these types of exams don't look at airway protection rigorously.
Barium swallow test may be used in the diagnosis of a wide range of pathologies including esophageal motility disorders, strictures, and perforations.
During a modified barium swallow study, swallowed contents may be seen to travel between the vocal folds into the lungs. The videofluorographic swallowing study (VFSS) is the definitive test to identify aspiration and other abnormalities of swallowing.
Teramoto S, Fukuchi Y. 2000; 81:1517–1519. doi: 10.1053/apmr.2000.9171. Arch Phys Med Rehabil. First, your SLP may ask you questions about the following: The nature of your swallowing problems, such as food sticking in your throat or pain while swallowing The American Speech-Language-Hearing Association, or ASHA, uses the term videofluoroscopic swallowing study, or VFSS.
When a VFSS is not feasible, nonvideofluorographic (non-VFG) clinical assessment of swallowing is essential. Due to older age, stroke, surgical procedures, and various other factors, many patients have trouble swallowing after cardiac surgery. The VFSS lets the SLP see: if food goes into your airway instead of your stomach, called aspiration Background: Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors.
5–7,14 This study assessed desaturation at both the 2% and 5% level and assessed maximum rather than mean desaturation to improve predictive yield. Results Pulse oximetry reliably predicted aspiration or lack of it in 81.5% of cases.