A videofluoroscopic swallow study, often called a modified barium swallow study (MBS), is a specialized X-ray procedure used to evaluate how a person swallows. It captures real-time images of the mouth and throat as food and liquids move through them, helping medical professionals understand swallowing mechanics and pinpoint difficulties.
Why the Study is Performed
Individuals undergo a videofluoroscopic swallow study for symptoms like coughing or choking during meals. A common complaint is a sensation of food sticking in the throat, which can indicate impaired muscle function. Unexplained weight loss may also prompt this study, as swallowing difficulties can lead to inadequate nutritional intake. Recurrent pneumonia, particularly aspiration pneumonia, is another indicator, suggesting food or liquid might be entering the airway instead of the stomach. Changes in voice quality after eating or drinking, such as a gurgly sound, can also signal a swallowing issue.
Underlying medical conditions frequently necessitate a videofluoroscopic swallow study to assess their impact on swallowing function. Patients who have experienced a stroke often develop dysphagia, or difficulty swallowing, due to neurological damage. Various neurological disorders, including Parkinson’s disease, amyotrophic lateral sclerosis (ALS), or multiple sclerosis, can progressively affect the muscles involved in swallowing. Head and neck cancers, along with their treatments like radiation or surgery, can directly impair swallowing mechanisms. Age-related changes in muscle strength and coordination can also contribute to swallowing difficulties in older adults.
The study helps determine whether food or liquid is entering the airway (aspiration) and identifies which parts of the mouth and throat are not working effectively. This detailed observation helps clinicians understand specific physiological impairments, such as reduced tongue movement or delayed swallow initiation. The information gathered then helps determine the safest food and liquid consistencies for the individual.
Preparing for and Undergoing the Study
Before a videofluoroscopic swallow study, patients receive specific instructions to ensure accurate results. These may include fasting for a period, often four to eight hours, prior to the appointment. Medication adjustments are generally not required, but patients should confirm with their healthcare provider. Bringing a list of current medications is advisable.
The study takes place in a radiology or X-ray department, usually involving a speech-language pathologist (SLP) and a radiologist. The patient will be positioned next to the X-ray machine, either sitting or standing, for optimal viewing of the swallowing process.
During the procedure, the SLP provides various consistencies of food and liquid, such as thin liquids, thickened liquids, soft foods, and solid foods. These items are mixed with a small amount of barium, a contrast material that appears opaque on X-ray images.
As the patient swallows each item, real-time X-ray imaging captures a “movie” of the food and liquid moving through the mouth, throat, and into the esophagus. This allows observation of the entire swallowing process and identification of deviations. The X-ray machine is activated only during the actual swallow, minimizing radiation exposure. The study typically lasts 15 to 30 minutes.
Understanding the Results
The videofluoroscopic swallow study provides detailed information about the specific swallowing difficulties an individual may be experiencing. It can identify issues such as a delayed swallow reflex, where the swallow is not initiated quickly enough, or reduced tongue movement, which can hinder the proper propulsion of food. The study may also reveal cricopharyngeal dysfunction, a problem with the muscle at the top of the esophagus that needs to relax to allow food passage.
The study detects aspiration, which occurs when food or liquid enters the airway instead of the stomach. It can differentiate between overt aspiration, where the patient coughs or shows other clear signs, and silent aspiration, where material enters the airway without any outward symptoms. Silent aspiration is particularly concerning as it poses a significant risk for respiratory complications like pneumonia without the patient’s awareness.
The findings from the study directly guide the diagnosis and the development of a personalized treatment plan. This plan may include dietary modifications, such as recommending thickened liquids or pureed foods to improve swallowing safety. Swallowing exercises, designed to strengthen specific muscles involved in the swallow, can also be prescribed.
Compensatory strategies, such as specific head positioning or swallowing maneuvers (e.g., a chin tuck), may be taught to help direct food safely. If other medical issues are identified, the patient may be referred to other specialists for further evaluation or treatment. The SLP and radiologist discuss observations after the study, and results are communicated to the patient and referring physician with a detailed report.