Imaging Studies

See the list below:

A modified barium swallow technique with videofluoroscopy examines upper aerodigestive function. This study is considered the criterion standard in the evaluation of swallowing function.
- During the study, the patient swallows food and liquids of varying consistency mixed with a small amount of barium while in the fluoroscopy suite.
- The image is adjusted to view the lips, the soft palate, the posterior pharyngeal wall, and the cervical esophagus.
Ultrasonography can be useful in studying the oral swallowing phase.
- This imaging study avoids the use of radiation and allows the visualization of the actual tongue surface instead of the swallowed bolus.
- Abnormalities of tongue movement, tongue and palate approximation, and hyoid elevation can be detected.
Radionuclide scintigraphy can measure the severity of aspiration.
- To facilitate this imaging study, the patient swallows a small amount of water with technetium-99m.
- While the patient lies under the scintillation camera with a computerized counting device, the radiologist compares the amount of radioactive material entering the lung to the total radioactive count and calculates the percentage of aspiration.

Diagnostic Procedures

See the list below:

The functional endoscopic evaluation of swallowing involves positioning a flexible nasopharyngoscope just posterior to the soft palate. This position allows for observation of the hypopharynx and the larynx while the patient is fed various consistencies of food dyed with coloring to aid visualization. Sensory testing can be performed using a calibrated puff of air delivered to the supraglottic larynx. See the images below.

Type I laryngeal cleft with posterior penetration during functional endoscopic evaluation of swallowing (FEES).
View Media Gallery

Type II laryngeal cleft. Note the abnormally posterior position of the endotracheal tube in the glottis.
View Media Gallery

See the list below:
- Parameters that can be evaluated include pharyngeal pooling, premature spillage, laryngeal penetration, aspiration, and residue.
- The benefits of this technique over the rehabilitative swallow study include the ability to assess pharyngeal sensation and the absence of radiation exposure. The disadvantages include that the test is mildly invasive. In addition, evaluation is limited to the events immediately before and after the swallow event, with the preparatory and oral phases of the swallow only indirectly evaluated and no evaluation of the esophageal phase.
Manometry uses a catheter passed through the pharynx into the esophagus to measure pressure changes. When used with videofluoroscopy, this procedure can be helpful in identifying cricopharyngeal dysfunction.

Treatment & Management

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Media Gallery

Type II laryngeal cleft. Note the abnormally posterior position of the endotracheal tube in the glottis.
Type I laryngeal cleft with posterior penetration during functional endoscopic evaluation of swallowing (FEES).
Base of tongue thyroglossal duct cyst in infant presenting with dysphagia and aspiration without associated stridor or airway obstruction.

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Author

Mark E Gerber, MD Clinical Associate Professor of Surgery, University of Chicago Pritzker School of Medicine; Division Head, Otolaryngology-Head and Neck Surgery; Director, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University Health System

Mark E Gerber, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, American Academy of Pediatrics, American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert M Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University

Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Emeritus Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Neosoma; MI10;<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10 advisor.

Additional Contributors

John M Truelson, MD, FACS Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas

John M Truelson, MD, FACS is a member of the following medical societies: American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Phi Beta Kappa, Texas Medical Association

Disclosure: Nothing to disclose.

Sections Surgical Management of Chronic Aspiration
Overview
Workup
Treatment
Media Gallery
References

Surgical Management of Chronic Aspiration Workup

Imaging Studies

Diagnostic Procedures

References

Tables

Contributor Information and Disclosures

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