Three Types of Dysphagia Evaluations

Dysphagia, a swallowing problem, which can cause coughing, choking, and aspiration pneumonia, is usually evaluated by a speech language pathologist by one of three methods: Video Fluoroscopy Swallow Study, Fiber-optic Endoscopic Evaluation of Swallow, and Bedside Swallow Evaluation.

 1.) Video Fluoroscopy Swallow Study (VFSS), which is also called a Modified Barium Swallow Study (MBSS). This is a video x-ray of your mouth and throat while you eat and/or drink food or liquids mixed with barium so that they show up on the x-ray. This test allows the speech language pathologist to see what is happening inside as you swallow in order to determine if it is being aspirated into the lungs or remaining as dangerous residue in the pharynx.

2.) Fiberoptic Endoscopic Evaluation of Swallowing (FEES) or a Bedside Swallow Evaluation is performed using a laryngoscope, which is a small tube with a camera on the end which is inserted into the nose so that the SLP can see what happens when you eat or drink foods or liquids which have green food coloring in them for contrast with the pharyngeal anatomy.

3.) Bedside or Clinical Swallow Evaluation. This evaluation is not always performed "bedside", as the name implies. This evaluation is commonly performed on patients in hospitals, skilled nursing facilities, or home health care who are suspected to have dysphagia. It can also be done in an outpatient clinic. It is simply an evaluation done by the speech language pathologist observing you while you eat and drink. There are many signs of aspiration (couging, choking, clearing the voice, gurgly or wet vocal quality during meals, eyes watering, skin color changes) and other problems she will look for. This evaluation should be performed by an SLP who is experienced in assessing and working with dysphagia patients.

The Bedside, or Clinical, Swallow Evaluation must be done by a speech language pathologist who has thorough training and experience doing this type of evaluation in order to be a reliable assessment. I think it can actually be more accurate than the VFSS at times. The VFSS is a video x-ray of you swallowing just a few times. If you only aspirate food or liquids into your lungs 1 out of 10 swallows, that could still be a very serious problem, but you might "get lucky" and not aspirate during the swallow test. They would tell you everything looks good, but you really could still be at high risk for choking or getting aspiration pneumonia. During a bedside swallow evaluation the SLP will usually watch you eat an entire meal. The FEES evaluation can be very good also, if you don't mind the minor discomfort of having a tube passed through your nose.

None of the tests are final. The real test is your health. If you continue to have problems which seem to be related to swallowing, such as coughing, choking, dehydration, recurrent bronchitis or pneumonia after being told that you "passed the swallowing test", don't give up on finding an answer. One test can easily be wrong. Have another test done. 

Talk to your doctor about your options, but definitely you should be evaluated if there are any concerns, especially if you are in a high risk group for dysphagia: stroke survivors, Parkinson's disease, Alzheimer's disease, TBI, dementia, Down's Syndrome, Multiple Sclerosis, etc.). Dysphagia can be a very dangerous problem which may only get worse without treatment, and treatment exercises are very easy, especially when you catch it early!

ABOUT THE AUTHOR:  Jolie Parker, M.S.CCC-SLP is a speech language pathologist who specializes in treating dysphagia patients in her private practice, Alternative Speech and Swallowing Solutions in Altamonte Springs, FL. She is co-inventor of the ISO Swallowing Exercise Device and author of the ASHA approved CEU course for speech language pathologists: Using the ISO Swallowing Exercise Device in Dysphagia Therapy.