Non-Contrasted Tasks

- Simple speech tasks to evaluate structures in movement (lips, tongue, velum,

pharyngeal wall)
- Vowel prolonga on and repe on to evaluate laryngeal excursion and VF adduc on
- False o /i/ in A-P view a ords good visualiza on of pharyngeal wall constric on
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 Materials Used
- Must use radiopaque barium (barium sulfate suspension)
- Varibar
- Standardized barium line speci cally designed for swallow studies, premixed

- Use range of textures, volumes, and viscosi es

- Volumes typically range from 1 mL to 20 mL
- But, perhaps more and perhaps less
- May look at what their natural amount is
- Viscosi es:
- Liquids – thin, nectar, honey
- Solids – puree, mechanical so , hard/solid, mixed
- Barium pill if needed
- Who feeds? To cue or not to cue?

Sequence of Events
- Can be di erent across se ngs & clinicians opinions vary
- Mar n-Harris suggests:
- Start with thins: 5 mL, 10 mL, 20 mL*
- Then: pudding, so , regular, mixed or pt speci c
- * If signs of aspira on, immediately downgrade to thicker viscosity
- Logemann protocol:
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 - 2 mL thin liquids, then con nue to proceed to 2 swallows each of 3, 5, and 10
mL. Same for other liquids
- Then 3 mL pudding, 3 mL solid
- Standard protocol bene cial but prac ce exibility to maximize diagnos c
outcomes
- General Sequence
- Pt seated in lateral view
- (Simple speech tasks to assess movement of structures)
- Liquid bolus presenta ons
- Solid bolus presenta ons*
- Pt turned to A-P view, vowel & false o tasks
- Further swallow trials. Assess symmetry & e ects of head turn as appropriate
- *Assess impact of compensatory maneuvers either before or a er A-P view
- When feasible, pt stands and cursory esophageal sweep
- What to look for:
- Anatomy of all structures
- Non-swallow movement: lips, tongue, mandible, larynx, pharynx
- Swallow movement
- Oral containment; mas ca on; oral transit; oronasal separa on
- Hyoid movement; laryngeal eleva on & closure; pharyngeal constric on
- UES opening
- Consequences of impaired swallow physiology
- Spillage; residue; misdirec on of bolus and airway compromise
- Impact of compensatory maneuvers
- Postural adjustment; head posi on changes; breath hold maneuvers; swallow
ming changes
- Bolus changes (e.g., bolus viscosity)
- Measures/Observa ons Made
- Lateral View
- Oral and pharyngeal transit mes
- Analysis of pa erns of lingual movement
- Gross es mate of amount of vallecular residue a er swallow
- Es mate of amount of material aspirated per bolus as well as anatomic or
physiologic reason for aspira on
- Presence of delayed swallow response ( me lapse between beginning bolus
movement past rim of mandible to beginning of hyoid eleva on)
- Timing of aspira on rela ve to triggering of pharyngeal swallow (before,
during, a er the swallow)
- A-P View
- In A-P view, bolus enters pharynx, lls valleculae, gives split appearance
because of hyoepiglo c ligament at midline that subdivides valleculae
- Bolus divides and goes around airway into pyriform sinuses
- Note whether bolus divides equally (symmetry)
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 - May have pt lt head back in this posi on and have vocalize to view vocal fold
movement
- What is causing what we see?
- Remember, we always want to link the radiographic signs to disordered
physiology (and/or anatomy)
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 Strengths & Weaknesses
- Strengths:
- Dynamic study of swallow biomechanics
- Unlimited review capabili es
- Comprehensive perspec ve from lips to esophagus
- Readily accessible (inpa ent)
- Weaknesses:
- Time restraints d/t radia on exposure
- Sampled in ar cial ea ng environment
- Pooled secre ons not captured

Lab
4- nger palpa on (gross measure of hyolaryngeal eleva on, signals swallow)
- Index nger: BOT
- Middle: hyoid bone
- Ring: superior thyroid
- Pinky: inferior thyroid

- Note swallow/respira on coordina on

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