Videofluoroscopic Swallow Study And Dysphagia

Running head: VIDEOFLUOROSCOPIC SWALLOW STUDY

The Videofluoroscopic Swallow Study and Dysphagia

The Videofluoroscopic Swallow Study and Dysphagia

The videofluoroscopic evaluation of swallowing, also known as the modified barium swallow, is considered to be the “gold standard” in the identification and evaluation of dysphagia (McMullough, Wertz, Rosenbek, & Dinneen, 1999). According to Wilcox, Liss, and Siegel (1996) “the procedure incorporates a set of modifications in bolus size, texture, patient positioning, and radiographic focus to facilitate optimum visualization of the oral-pharyngeal-laryngeal structures and their function during swallowing” (pg. 144). The Speech-Language Pathologist utilizes radiographic, or X-ray technology, to visualize the structure and function of the swallow.

The American Speech-Language-Hearing Association (ASHA) reports that the videofluoroscopic swallow study is the primary diagnostic tool utilized by Speech-Language Pathologist’s in dysphagia (2004). Although no one professional is attributed to the development of the procedure, Jeri A. Logemann has been one of the primary professionals in the development and delivery of this procedure (Logemann, 1994).

According to the American Speech-Language-Hearing Association (2004) the prevalence of swallowing disorders in individuals 50 years and older is up to 22%. The videofluoroscopic swallow study (VFSS) is used with infants, children, and adults who demonstrate characteristics of a swallowing disorder (2004). The VFSS has been effective in identifying both aspiration and silent aspiration in patients with nasopharyngeal cancer (Chang et al., 2003). In a class three, cross-sectional case study Chang et al. reported that the VFSS was effective in identifying silent aspiration in 96.8% (60/62) of patients (2003). According to the class two clinical study performed by O'Neil-Pirozzi, Lisiecki, Momose, Connors, and Milliner (2003), the modified barium swallow (MBS) test was more accurate in identifying aspiration than the blue dye test (BDT) in patients with tracheostomies. The BDT did not identify aspiration in 20% of tracheostomized patients according to the MBS test (2003). In a class three, retrospective literature review, Doggett et al., determined that the videofluoroscopic swallow study is also effective in identifying dysphagia and aspiration risk in stroke patients (2001). The VFSS has been documented by peer-reviewed journals to be an effective diagnostic and therapeutic tool in differing dysphagia populations.

Wilcox, Liss, and Siegel (1996) assessed the reliability of the VFSS in a randomized class two, clinical study. They randomly chose ten speech-language pathologists (with varying years of experience) and three patients with dysphagia to evaluate their videofluoroscopic swallow studies. The intra-observer agreement was determined to be relatively poor. Wilcox, Liss, and Siegel report that the poor intra-observer agreement is likely due to the varying years of experience of the SLP’s participating in the study (1996).

In contrast to the Wilcox, Liss, and Siegel (1996) study, a class two, international multi-centered study by Stoeckli, Huisman, Seifert, and Martin-Harris (2003) determined the inter-rater reliability of 51 modified barium swallow studies.

“Nine independent, experienced observers” (pp.53) agreed on the presence of aspiration in 90% of the observations. It should be noted that the credentials of the independent observers is not clearly identified by Stoeckli et al. (2003).

The accurate identification of dysphagia and aspiration make the videofluoroscopic swallow study an invaluable tool. However, SLP’s often experience difficulty obtaining the study (Shelley, 1995). The distance to the nearest facility with the appropriate technology and a lack of a competent professional to perform the swallow study are issues faced by practicing SLP’s in some rural areas (1995). Patient or physician refusal to consent to the procedure and the inability to move medically fragile patients are also issues experienced by the SLP that inhibit the VFSS (1995).

Aviv et al. (2001) performed a prospective study to determine the cost-effectiveness of two diagnostic procedures in dysphagia: the modified barium swallow study and the flexible endoscopic evaluation of swallowing with sensory testing (FEEST). Aviv et al. compared the Medicare reimbursement for the two procedures. This study determined the average reimbursement for the MBS to be $451.01 as compared to the average FEEST reimbursement at $321.23.

While the VFSS is relatively harmless, there are potential risks to both the patient and the clinician. It is possible that during the evaluation the patient may aspirate potentially harmful fluids. The clinician performing videofluoroscopic swallow studies may be exposed to minimal levels of radiation. Although precautionary measures should be and are taken by radiologists, physicians, and SLP’s, the superior diagnostic measure provided by the VFSS outweighs the minimal risks associated with radiation and aspiration.

The American Speech-Language-Hearing Association reports that 85% of Speech-language Pathologists are the only professional in their facility servicing this population (2004). According to ASHA’s (2001) “Scope of practice in Speech-Language Pathology”, the Speech-Language Pathologist may provide the diagnosis and intervention for feeding and swallowing disorders. The SLP should gain the appropriate training and experience in order to