Role of the modified barium swallow in management of patients with dysphagia.

Published on Mar 1, 1997in Otolaryngology-Head and Neck Surgery2.341
· DOI :10.1016/S0194-5998(97)70269-9
Jeri A. Logemann76
Estimated H-index: 76
(NU: Northwestern University)
Sources
Abstract
Abstract The modified barium swallow is a radiographic (videofluoroscopic) procedure designed to define the anatomy and physiology of the patient’s oropharyngeal swallow and examine the effectiveness of selected rehabilitation strategies designed to eliminate aspiration or excess oral or pharyngeal residue (the symptoms of the patient’s dysphagia). Rehabilitation strategies introduced during the modified barium swallow after the patient’s oropharyngeal anatomy and physiology have been defined include (1) postural changes to redirect food flow and change pharyngeal dimensions, (2) sensory enhancement techniques, and (3) swallow maneuvers. Combining the modified barium swallow with a follow-up swallowing rehabilitation plan can decrease the cost and time for rehabilitation of patients with dysphagia. In some cases the patient can begin safe oral intake immediately after the modified barium swallow, and therapy may not be needed if consistent spontaneous recovery is anticipated. (Otolaryngol Head Neck Surg 1997;116:335-8.)
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#1Jeri A. LogemannH-Index: 76
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This study was designed to define the effects of postural change on liquid aspiration during videofluorographic examination of oropharyngeal swallow in head and neck surgical patients. Thirty-two patients were given two swallows of five different amounts of liquid barium as tolerated. When aspiration occurred, the patient's head and/or body position was changed, new posture being determined by the swallowing disorder identified as the cause of the aspiration. Postural techniques were successful ...
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#1Jeri A. Logemann (NU: Northwestern University)H-Index: 76
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Speech and swallowing function was examined in 11 patients who underwent surgical resection of greater than 1 cm of tongue base, tonsil, and faucial arch with mandible resected on the side of the t...
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This study examined the effects of three swallow maneuvers: (1) the supraglottic swallow (voluntary closure of the vocal folds prior to the swallow); (2) the super-supraglottic swallow (airway closure at the level of the arytenoid to base of epiglottis); and (3) the Mendelsohn maneuver (voluntary prolongation of laryngeal elevation and cricopharyngeal opening during swallow) on swallow functioning in a 47-year-old patient who underwent right composite resection for a squamous cell carcinoma of t...
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Abstract Use of the chin-down posture during swallowing has been reported to reduce the occurrence of aspiration in some dysphagic patients. This study measured four pharyngeal dimensions in 30 neurologically impaired patients who aspirated before the swallow because of a delay in triggering the pharyngeal swallow, 15 for whom the posture eliminated aspiration and 15 who aspirated despite the chin-down position. Patients who did not benefit from the posture were significantly younger and aspirat...
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We investigated the frequency with which changes in the position of a patient's head or body eliminated aspiration of liquid barium during videofluoroscopic swallowing studies in patients with oropharyngeal dysphagia. We also studied factors that influenced the effect of posture on aspiration.The study group comprised 165 patients consecutively referred for videofluoroscopic examination of the oropharyngeal stages of swallowing in whom aspiration of barium occurred while swallowing 1, 3, 5, or 1...
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Abstract This study measured the pharyngeal dimensions of 30 subjects when their heads were in an upright neutral position and in the chin-tucked position. Two videoprints of lateral radiographic views of the oral cavity and pharynx were made for each subject: one with the head in neutral position and one with the chin tucked. A 1-cm metal ruler was taped at midline on the front of each patient's neck to account for radiographic magnification of the image. Three angles and three distance measure...
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Synchronized videonasendoscopy and respiratory recordings were conducted in six healthy male subjects to evaluate activity of the arytenoid cartilages, true vocal folds, false vocal folds, and epiglottis during repeated trials of three breath-hold maneuvers:easy hold,inhale hard hold, andinhale/exhale hard hold. Five of the six subjects demonstrated maximal laryngeal valving on thehard breath-hold conditions. One subject showed maximal laryngeal valving on the EASY hold condition, and rarely dem...
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We report two young patients able to exist on exclusively oral intake despite an absent pharyngeal swallow response. Videofluoroscopic swallowing studies showed that both patients used a sequence of devised maneuvers rather than a coordinated pharyngeal swallow to move the bolus, protect the airway, and open the upper esophageal sphincter during bolus ingestion. We conclude that it is possible for young, highly motivated individuals to maintain oral intake despite ablation of neurologic elements...
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Studies were done on eight normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of the extent and mechanism of voluntary augmentation of upper esophageal sphincter (UES) opening during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal pressure events were determined at 1/30-s intervals during swallows of 1 and 10 ml of liquid barium. Swallows of each volume were obtained both before and after subjec...
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