How Do You Know My Food Went Down The Wrong Way?

When it comes to persistent coughing during meals or other signs of possible swallowing difficulties, your healthcare provider may recommend a swallowing assessment to determine if you have swallowing difficulty or dysphagia. It is vital to know if your difficulties during swallowing are causing aspiration, which can lead to aspiration pneumonia. The swallowing assessment that has been most commonly referred to by healthcare providers in this area has been a Modified Barium Swallow (MBS), or rather a Videofluoroscopic Swallow Study (VFSS). However, South Central Louisiana has access to a new GOLD standard for swallowing assessments, Flexible Endoscopic Evaluation of Swallowing (FEES). Healthcare providers are beginning to see the advancements and advantages of FEES.

The Modified Barium Swallow Study (MBSS) is conducted as an inpatient or outpatient procedure in the hospital setting. The MBSS is performed by a speech language pathologist (SLP) with the assistance of a radiologist or radiology tech. The MBSS assesses the 3 phases (oral, pharyngeal, and esophageal) of a person’s swallow. The patient is prepared for radiation exposure with a lead apron and is placed in either a seated or standing position.The procedure takes approximately 10-15 minutes, however it is limited to a maximum of 3 minutes of actual footage due to acceptable radiation exposure. The SLP views multiple consistencies of food and liquids, usually thin, nectar, and honey thickened liquids, puree (applesauce or pudding), chopped (fruit), and solid (cracker) consistencies, mixed with a small amount of barium. Barium is a radiopaque medium that is visible in x-rays. During the assessment, the SLP gives the patient the various consistencies and assesses the quality of their swallow. The SLP can visualize residue and/or any aspiration through the x-ray images and video. The SLP may ask the patient to perform different actions during the swallow to help identify safe swallowing strategies, such as turning head to one side, putting chin down, coughing, holding breath, etc.

The Flexible Endoscopic Evaluation of Swallowing, FEES, procedure also assesses a patient’s swallowing function. The FEES is performed using instrumentation that offers real-time, color-video, which is more affordable than the MBSS. Since the instrumentation does not utilize radiation or barium, a radiologist and hospital are not necessary. The FEES assessment is performed by a highly trained SLP. The procedure is performed at the bedside, in the patient’s home, nursing home, or assisted living center, essentially wherever the patient is located. The procedure eases a lubricated, thin, flexible endoscope through the patient’s nose to the back of the throat. A tiny, fiber-optic camera at the end of the tube records the anatomy and function of the patient’s swallow. The patient is seated comfortably and, like the MBSS, is presented with foods and liquids of different consistencies. The procedure also takes about 10-15 minutes. The FEES does not limit the viewing time allowed because there is no exposure to radiation. After the assessment, a detailed report with images, high-quality video, and recommendations are sent to the patient’s healthcare provider.

Both swallow assessments aim to identify signs of swallowing difficulty or dysphagia. Of the outlined similarities and differences between the two, FEES provides the patient with more detailed high definition images and video-results with no exposure to radiation. Louisiana Voice and Swallow Solutions offers FEES on-site with results and recommendations immediately following the assessment. FEES assessments are accepted by Medicare, Medicaid, and most private health insurance plans.

Contact Louisiana Voice and Swallow Solutions for additional information at (225)269-9971.