What is the role of videofluoroscopy in the workup of dysphagia?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Videofluoroscopy is designed to study the anatomy and physiology of the oral, pharyngeal, and esophageal stages of deglutition. It is considered the standard for identifying patients who have the potential to develop pneumonia and for diagnosing aspiration and swallowing problems. [42] It is also used in determining dietary and compensatory strategies. (The terms videofluoroscopic swallowing study [VFSS] and modified barium swallow [MBS] often are used interchangeably.) [43]

Although some clinical researchers believe that it is possible to identify patients with the potential to develop pneumonia by interpreting findings of bedside tests, most agree that discrepancies exist between findings of bedside tests and videofluoroscopy. [44]

Splaingard and colleagues reported that only 42% of patients who had aspiration on videofluoroscopy were diagnosed as aspirators by speech/language pathologists conducting bedside evaluations. [42] This finding indicated that bedside results are not sufficient for evaluating the frequency of aspiration. In general, 40-70% of patients have silent aspiration, which does not manifest specific symptoms.

If a patient undergoing a VFSS aspirates or if he/she retains food after swallowing, the next step is to evaluate the quantity of retained food, the mechanism of retention or aspiration, and the patient's response. In general, various food consistencies, volumes, postural techniques, and swallowing maneuvers to enhance swallowing efficiency or safety are tested during the study, and clinical decisions (eg, changing food viscosity, finding appropriate swallowing postures or maneuvers) are made.

This study is expensive because of the special expertise, equipment, and facilities required. (See the images below of videofluoroscopic swallowing findings.)

Lateral projection of the videoprint of a videogra Lateral projection of the videoprint of a videographic swallowing study shows the epiglottis (E), pyriform sinuses (P), tongue (Tg), trachea (Tr), and vallecula (V).
Lateral projection of the videoprint of a videogra Lateral projection of the videoprint of a videographic swallowing study shows residues on the vallecula (Vr) and pyriform sinuses (Pr) and a small amount of aspirated liquid barium in the trachea (As).
Anterior projection of the videoprint of a videogr Anterior projection of the videoprint of a videographic swallowing study shows residues on the vallecula (Vr) and pyriform sinuses (Pr).
Lateral projection of the videoprint of a videogra Lateral projection of the videoprint of a videographic swallowing study shows supraglottic penetration.
Lateral projection of the videoprint of a videogra Lateral projection of the videoprint of a videographic swallowing study shows subglottic aspiration.

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