Radiographic Evaluation of the Oral/Preparatory and Pharyngeal Phases of Swallowing Including the UES: Comprehensive Modified Barium Swallow Studies

Abstract

The normal oropharyngeal swallow involves rapid neuromuscular actions to move food or liquid through the mouth and pharynx and into the esophagus in two seconds or less. Evaluation of the normal or abnormal swallow is most often completed using a radiographic videofluoroscopic procedure known as the modified barium swallow (MBS) procedure described in detail in this chapter. The MBS has 3 purposes: 1) To identify the presence and the cause of any aspiration; 2) To identify the presence and cause of any oral or oropharyngeal residue after the swallow; 3) To identify treatment strategies that can improve the patient’s swallow. During the MBS various volumes of thin liquids from 1 ml to cup drinking, measured viscosities from thin liquid to nectar, puree, and solid food, voluntary controls including timing and effort of airway closure, increasing muscular effort, etc. and sensory stimulation techniques including boluses of various tastes and carbonation can be introduced as described in the chapter. These procedures are assessed for their effectiveness in improving the oropharyngeal swallow and returning the patient to full oral intake as quickly and safely as possible.