A modified barium (videofluoroscopic) swallow examination serves several purposes in providing quality care to patients within your facility. It is useful in determining the physiological basis of a patient's dysphagia, the safest/least restrictive oral diet level, and strategies to help reduce aspiration and choking risk. In addition, the study assists the clinician in identifying the appropriate treatment plan and treatment techniques that may be useful in the patient's plan of care.
As with any medical procedure, medical necessity must be substantiated. The following information is provided to ensure appropriate utilization of the procedure and to help guide you in making a referral.
A. To visualize the structures of the upper aerodigestive tract and assess the physiological functioning of the muscles and structures involved in deglutition.
B. To assess the lingual, velopharyngeal, pharyngeal, and laryngeal movements during deglutition, including coordination, timing, and effectiveness of these movements in propelling foods/liquids safely into the upper esophagus.
C. To visualize the flow and control of a food or liquid bolus within the oral cavity, pharynx, and upper esophagus.
D. To determine the timing of the swallow response.
E. To determine the adequacy of airway protection before, during, and after the swallow.
F. To assist in determining the safest/least restrictive oral diet.
G. To determine if, when, and why aspiration occurs so an appropriate treatment plan can be initiated.
H. To determine the efficacy of modifying bolus amounts, textures, and viscosity in order to reduced risk and/or /prevent aspiration.
I. To determine the efficacy of modifying the patient's posture and/or compensatory swallowing strategies to reduce risk and/or prevent aspiration.
J. To screen the upper 1/3 of the esophagus for abnormalities, including structural defects, dysmotility, and potential gastroesophageal reflux.
A modified barium swallow examination is indicated for patients who have a suspected oropharyngeal dysphagia based on the findings of the clinical swallow evaluation as well as for patients with known history of aspiration. Further evaluation via the MBS videofluoroscopic swallow study is indicated to further assess the safety and efficiency of the swallow when one or more of the following common symptoms are present:
- Coughing, choking, and/or gagging on food or liquids
- Wet vocal quality or excessive throat clearing associated with food/liquid intake
- Prior history of aspiration or pharyngeal dysphagia with recent progress demonstrated in therapy (reevaluation indicated)
- Prior history of aspiration or pharyngeal dysphagia with noted decline in status
- Patient complaints such as swallowing difficulty, sensation of food stuck in throat, regurgitation of food, sensation of food coming back up, fatigue when eating, increased SOB when eating/drinking
- Suspected delayed swallow response (as identified on a clinical swallow evaluation)
- Multiple swallows needed per single bite/sip
- History of recurrent pneumonia (especially involving the RLL)
- Respiratory difficulty/distress associated with eating/drinking
- History of malnutrition, unexplained weight loss, and/or dehydration
- Poor oral intake that appears to be due to difficulty swallowing
- Drooling and/or difficulty managing oral secretions
- Holding/pocketing food within the mouth
A. The patient is unable to participate in the study due to reduced mental status/lethargy and/or agitation or combativeness with significant refusal behaviors.
B. The patient is allergic to barium sulfate contrast.
C. The patient is medically unstable (may include any of the following: vomiting, active GI bleed, dyspnea with SPO2 less than 90%, hypotension).
D. The patient is orally intubated.
E. The patient or family has refused to consent to the procedure.
F. The patient or family has determined that they will not comply with therapy or will alter the current plan of care regardless of study findings.