Sometimes a person can silently aspirate, which happens when food or liquid enters the lungs but the person is not aware. In those cases, the person may be referred for a Modified Barium Swallow (MBS) study or a Fiberoptic Endoscopic Evaluation of Swallowing and Sensory Testing (FEES/ST).
Modified Barium Swallow Study
The MBS can provide detailed information about the safety of a person’s swallow. The MBS is conducted in a radiology suite in the presence of a radiologist. The person is tested with various food and liquid consistencies to determine choices for oral intake. For this test, the food is mixed with a contrast material, called barium, which makes it visible on the x-ray. The person is x-rayed as he or she eats each food consistency. Unlike a static x-ray, which reflects one single instant in time (like a chest x-ray), and is viewed as a photograph, the MBS is a moving x-ray that records the swallow from the oral-preparatory phase to the esophageal phase. The recording of the test can be reviewed at a later date for comparative purposes or to determine progress from receiving a form of swallowing therapy.
The Modified Barium Swallow serves several important functions in the diagnosis and management of swallowing disorders.
- It allows the clinician to directly visualize the swallow in order to determine whether there is laryngeal penetration (pooling or stasis of swallowed material above the level of the vocal folds) or aspiration.
- It provides the clinician with information regarding the safest consistencies for the person to eat and drink.
- It helps to determine therapeutic strategies for improving swallowing safety.
Fiberoptic Endoscopic Evaluation of Swallowing & Sensory Testing (FEESST)
FEESST is an alternative test to the X-ray test of swallowing that uses a specifically designed endoscope in order to assess both the SENSORY and MOTOR components of the swallow.
FEESST is a two-part test. The first part of the test assesses sensation in the larynx in order to elicit an airway protective reflex (the Laryngeal Adductor Reflex). The second part of the test involves giving food to the person (with green food coloring mixed in) and tracking where the food travels in the throat region.
Velopharyngeal closure, anatomy of the base of the tongue and hypopharynx, abduction and adduction of the vocal folds, pharyngeal musculature and the person’s ability to manage his/her own secretions are assessed.
Benefits of FEESST:
- Immediate results including dietary recommendations.
- Office procedure.
- No anesthetic
- Portable capabilities.
- Non-radioactive alternative to MBS studies
- Facilitates the development of a specialized therapy program by identifying which swallowing therapies are most useful for the specific impairment(s) noted during the exam.