Evaluation of Patients with Swallowing Difficulties by Modified Barium Swallow

Abstract

Patients with swallowing difficulties are commonly encountered in the ENT OPD.Swallowing disorders can occur at any age but it is more common in the elderly patients.Neurological causes and malignancy account for the main reason in most of the cases.The modified barium swallow provides information about the complex split second events underlying the swallowing process. We can evaluate the effectiveness of swallowing manouveres by which we can prevent aspiration in patients with pharyngeal retention. AIMS 1.To study the various phases of swallowing in patients with dysphagia by modified barium swallow 2.To identify the patients with risk of aspiration during swallowing 3.To study the effectiveness of swallowing manouveres by the modified barium swallow technique Materials and methods: 200 patients who attended ear, nose, and throat out patient department with history of swallowing difficulties for more than 3 months were included in the study.Modified barium swallow was done in all these patients. Patients with risk of aspiration were detected by the amount of pharyngeal retention in the pyriform sinuses and vallecula after swallowing.The patients with grade 3 severe form of pharyngeal coating were given training for postural technique and swallowing manoeuvres to prevent aspiration. Results: Out of the 200 patients, 92 patients were found to have abnormal findings during the study. Other 108 patients had normal findings on videofluoroscopy.Out of the 92 patients with the abnormal videofluoroscopic findings,28 patients have pharyngeal retention alone with no other structural abnormalities.We focussed mainly on the patients with pharyngeal retention.16 of them were found to have grade 3 severe pharyngeal retention.These patients had history of stroke in the past.They were given training on swallowing manouveres to prevent aspiration.We found that these manouveres are effective in doing so.Another 12 patients had pharyngeal retention with no aspiration risk and they were in between the 61-80 yrs.