A swallow study is a diagnostic assessment that evaluates how a person swallows. It helps healthcare professionals understand the mechanics of swallowing, identify difficulties, and pinpoint the nature of any swallowing problems. This assessment is crucial for developing strategies to maintain adequate nutrition and hydration.
Reasons for a Swallow Study
A swallow study is often performed when individuals exhibit signs of dysphagia, which refers to difficulty with swallowing. Common indications include coughing or choking during or immediately after eating and drinking, a sensation of food being stuck in the throat, or pain while swallowing. Some people may also experience unexplained weight loss, recurrent respiratory infections like pneumonia, or a wet, gurgly voice after consuming food or liquids. These symptoms suggest that food or liquid might be entering the airway instead of the esophagus, a condition known as aspiration.
Swallowing problems can arise from various underlying conditions affecting the coordination of muscles and nerves involved in this process. Neurological disorders, such as stroke, Parkinson’s disease, multiple sclerosis, or amyotrophic lateral sclerosis (ALS), frequently impair swallowing function. Individuals who have undergone head and neck cancer treatment, including surgery or radiation, may also develop swallowing difficulties. Advanced age can contribute to changes in swallowing mechanisms, making some older adults more susceptible to dysphagia. Certain medical procedures or injuries might also lead to temporary or persistent swallowing challenges, necessitating a comprehensive evaluation.
The Swallow Study Process
Preparation for a swallow study is generally minimal. For some assessments, individuals may be asked to avoid eating or drinking for a few hours beforehand. The procedure typically does not cause significant discomfort.
The Videofluoroscopic Swallowing Study (VFSS), also known as a Modified Barium Swallow (MBS), is a common type of swallow study performed in a radiology department by a speech-language pathologist (SLP) and a radiologist. The individual sits or stands in front of an X-ray machine and is given various food and liquid consistencies mixed with barium. Barium is a contrast material that appears on X-ray images, allowing the team to observe the swallowed material’s path in real-time. During the study, the SLP may ask the individual to try different head positions or swallowing techniques to determine if these strategies improve swallowing safety and efficiency. The X-ray images are recorded for later analysis.
The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is another frequently used assessment, involving a trained SLP or physician gently inserting a thin, flexible endoscope through the individual’s nose. The endoscope has a small camera and light at its tip, providing a direct view of the throat and voice box (larynx). As the individual swallows different colored food and liquid consistencies, the camera captures images of the swallowing structures. Unlike VFSS, FEES does not involve radiation exposure, which can be an advantage for certain individuals. It allows for detailed observation of secretions, tissue appearance, and the movement of structures in the throat, providing insights into muscle coordination and airway protection. This assessment can be performed at a patient’s bedside or in an outpatient clinic.
Interpreting Results and Next Steps
After a swallow study, the speech-language pathologist and radiologist review and discuss the findings with the individual and their referring physician. The study provides specific information about where the swallowing problem originates, what types of food or liquid textures are difficult to manage, and if aspiration (material entering the airway) is occurring.
Based on the study’s findings, a personalized management plan is developed. This often includes dietary modifications, such as recommending safer food textures or liquid consistencies like thickened liquids or pureed foods to reduce aspiration risk. Swallowing strategies, such as a chin tuck or head turn, may also be taught to help direct food and liquid more safely. Many individuals are referred for swallowing therapy with a speech-language pathologist, who provides exercises to strengthen swallowing muscles and improve coordination. If an underlying medical condition is identified, further medical evaluation or treatment may be recommended.