Surgical Management of Chronic Aspiration Workup

Updated: Aug 12, 2022
  • Author: Mark E Gerber, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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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

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  • 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 Type I laryngeal cleft with posterior penetration during functional endoscopic evaluation of swallowing (FEES).
    Type II laryngeal cleft. Note the abnormally poste Type II laryngeal cleft. Note the abnormally posterior position of the endotracheal tube in the glottis.

    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.