Three Evaluation Methods for Dysphagia
I. Clinical (bedside) evaluations
- Conducted at bedside
- Patients are observed eating. Signs of difficulty include:
- Coughing during or right after eating or drinking
- Wet or gurgly sounding voice
- Extra effort or time needed to chew or swallow
- Drooling
- Recurrent pneumonia or chest congestion after eating
- Weight loss or dehydration from not being able to eat enough
An instrumental study is indicated when:
- It is suspected that dysphagia may be contributing to either nutritional or pulmonary compromise
- There are clinical signs of pharyngeal dysfunction
- The safety and efficiency of the swallow remain a concern
- Specific information is needed to guide treatment
Additional indicators may include:
- Medical diagnoses that pose a high risk for dysphagia
- Neurologic
- Pulmonary or cardiopulmonary
- Gastrointestinal problems
- Immune system compromise
- Surgery and/or radiotherapy to the head and neck
- Cranio-facial abnormalities
- Previously diagnosed dysphagia with a change in swallow function suspected
- Patient has cognitive/communication deficits that interfere with obtaining a valid clinical exam
Instrumental Assessments
II. Videofluoroscopic swallowing studies (VFSS)
- Conducted in Radiology
- Patient is seated in a special chair
- Oral, pharyngeal and upper esophageal anatomy and physiology are evaluated during swallowing
- Bolus size, texture, swallowing maneuvers, and patient positioning are evaluated and modified to determine compensation that will allow the patient to swallow safely and identify treatment strategies that will aid in the recovery process
- Most often, the VFSS is the “gold standard” for thoroughly and accurately diagnosing oropharyngeal dysphagia and is preferable for:
- Detection of aspiration or penetration during the swallow
- Assessment of the oral stage of the swallow
- Assessment of bolus propulsion forces (such as tongue base retraction) and their effects on pharyngeal residue
- Judging the amount of aspiration that occurs
- Patients who cannot tolerate endoscopy (see FEES, below)
- Please note: A barium swallow or esophagram is performed by a radiologist and is used to rule out possible structural or functional abnormalities of the upper GI tract, especially the esophagus, such as tumors, hiatal hernias, diverticula, strictures, polyps, achalasia, GERD and ulcers.
III. Fiberoptic endoscopic evaluation of swallowing (FEES)
- Conducted at bedside or in the Voice Laboratory
- Uses a fiberoptic nasolaryngoscope to evaluate the pharyngeal swallow
- A camera is attached and the study is recorded
- The scope is passed through the patient’s nasal cavity and into the pharynx
- Bolus size, texture, swallow maneuvers and patient positioning are evaluated and modified as needed
- FEES studies are preferred over VFSS when:
- Transportation to Radiology is risky (with medically fragile patients)
- Positioning is problematic (contractures, neck halo)
- Patient weighs over 325 pounds (the videoswallow chair’s weight limit)
- Radiation concerns are present
- Frequent re-assessments are needed
- Laryngeal visualization is desired (voice changes, suspect laryngeal trauma)
- Velo-pharyngeal competence is compromised
- Aspiration of secretions needs evaluation
- Extended exams are indicated (to evaluate swallowing over the course of a meal, to assess the effects of fatigue)
- Biofeedback is warranted to enhance patient, family and caregiver education
Treatment
Treatment varies greatly depending on the cause, symptoms and type of swallowing problem. Exercises, positions, strategies, sensory enhancements, and specific food and liquid textures may be recommended.
Make An Inpatient Referral
Consults should be written as:
- “Speech-Language Pathology for Clinical Swallowing Evaluation and Treatment”
- “Speech-Language Pathology for Videoswallow Evaluation and Treatment”
- “Speech-Language Pathology for FEES Evaluation and Treatment”
Make An Outpatient Referral
Call United Hospital’s Sister Kenny Rehabilitation Institute’s Speech-Language Pathology Department at 651-241-8290 or fax your referral to 651-241-7177.
If unsure which exam would be most appropriate, simply consult “Speech-Language Pathology for Swallowing Evaluation and Treatment.” The speech-language pathologist will begin with a clinical exam and make recommendations for an instrumental study when one is indicated.
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