Academic literature on the topic 'Modified Barium Swallow'

AbstractBackground:Cricopharyngeal dysfunction following head and neck cancer treatment may lead to a significant reduction in oral intake. Carbon dioxide laser is an established procedure for the treatment of non-malignant cricopharyngeal disorders. We report our experience of laser cricopharyngeal myotomy with objective swallowing outcome measures, before and after treatment.Methods:We identified 11 patients who had undergone carbon dioxide laser cricopharyngeal myotomy for dysphagia following radiotherapy, with or without chemotheraphy between January 2006 and July 2011. We analysed the swallowing outcomes following carbon dioxide laser cricopharyngeal myotomy by retrospective grading of pre- and post-procedure videofluoroscopic swallowing study of liquids, using the validated Modified Barium Swallow Impairment Profile.Results:The median Modified Barium Swallow Impairment Profile score was 13 pre-myotomy and 10 post-myotomy. This difference between scores was non-significant (p = 0.41). The median, cricopharyngeal-specific Modified Barium Swallow Impairment Profile variables (14 and 17) improved from 3 to 2, but were similarly non-significant (p = 0.16). We observed the improved Modified Barium Swallow Impairment Profile scores post-procedure in the majority of patients.Conclusion:Endoscopic carbon dioxide laser cricopharyngeal myotomy remains a viable option in treatment-related cricopharyngeal dysfunction; its targeted role requires further prospective study. Objective analysis of the technique can be reported using the validated Modified Barium Swallow Impairment Profile.

Purpose The modified barium swallow study (MBSS) is a widely used videofluoroscopic evaluation of the functional anatomy and physiology of swallowing that permits visualization of bolus flow throughout the upper aerodigestive tract in real time. The information gained from the examination is critical for identifying and distinguishing the type and severity of swallowing impairment, determining the safety of oral intake, testing the effect of evidence-based frontline interventions, and formulating oral intake recommendations and treatment planning. The goal of this review article is to provide the state of the science and best practices related to MBSS. Method State of the science and best practices for MBSS are reviewed from the perspectives of speech-language pathologists (SLPs) and radiologists who clinically practice and conduct research in this area. Current quandaries and emerging clinical and research trends are also considered. Results This document provides an overview of the MBSS and standards for conducting, interpreting, and reporting the exam; the SLPs' and radiologist's perspectives on standardization of the exam; radiation exposure; technical parameters for recording and reviewing the exam; the importance of an interdisciplinary approach with engaged radiologists and SLPs; and special considerations for examinations in children. Conclusions The MBSS is the primary swallowing examination that permits visualization of bolus flow and swallowing movement throughout the upper aerodigestive tract in real time. The clinical validity of the study has been established when conducted using reproducible and validated protocols and metrics applied according to best practices to provide accurate and reliable information necessary to direct treatment planning and limit radiation exposure. Standards and quandaries discussed in this review article, as well as references, provide a basis for understanding the current best practices for MBSS.

Purpose The purpose of this study was to investigate factors influencing the initiation of pharyngeal swallow (IPS) in healthy, nondysphagic adults. Method A total of 195 healthy participants ranging in age from 21 to 89 years participated in a modified barium swallow study. IPS was quantified using the Modified Barium Swallow Impairment Profile standardized scoring system across nine swallowing tasks observed in the lateral viewing plane for each participant. Results Large variability for bolus head location at time of hyoid burst (IPS) was observed within this healthy cohort, ranging from the ramus of the mandible to the pyriform sinuses. Significant effects of bolus volume, viscosity, sex, and race were also observed. Conclusion Study findings indicate that IPS is variable in healthy adults and influenced by volume, viscosity, sex, and race. Thus, variability in IPS may be considered typical in otherwise nondysphagic adults. The clinical significance of high Modified Barium Swallow Impairment Profile IPS scores in dysphagic patients, therefore, must be considered within the context of other swallowing impairments. Supplemental Material https://doi.org/10.23641/asha.12735935

Purpose High-flow nasal cannula (HFNC) therapy is used increasingly in critically ill populations under respiratory distress. The interface between respiration and swallowing begs a better understanding of the effects of HFNC on swallow function. The current prospective cohort study investigated the effect of HFNC on swallow physiology in healthy adults. Method Eighty adults aged 35–65 years underwent modified barium swallow studies under varying flow rates of HFNC (0, 20, 40, and 60 liters per minute [lpm]). Modified barium swallow studies were scored by a blinded speech-language pathologist for 17 components of swallow function as defined by the Modified Barium Swallow Impairment Profile (MBSImP) and severity of penetration and aspiration as defined by the 8-point Penetration-Aspiration Scale ( Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996 ). Results Total MBSImP scores were statistically significantly higher at the highest flow rate (60 lpm) than those at any other flow rate. MBSImP components 1 (lip closure), 2 (tongue control during oral bolus hold), and 5 (oral residue) demonstrated statistical relevance to various flow rates. MBSImP components 12 (pharyngeal stripping wave) and 15 (tongue base retraction) were significant to age group. The 8-Point Penetration-Aspiration Scale scores were not significantly associated with flow rate nor age group. Conclusion The current study demonstrated that oral swallowing changes occur in healthy adults wearing HFNC at a high-flow rate (60 lpm). We postulate that healthy adults are able to compensate for swallowing changes while wearing HFNC; we suggest that cognition is a critical factor when evaluating patient populations for safe initiation of oral alimentation.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Dysphagia with aspiration (DA) is the most common presenting symptom of patients at Phoenix Children’s Hospital’s Aerodigestive Clinic (ADC). Dysphagia with aspiration is associated with respiratory and gastrointestinal symptoms, chronic oral thickener use to prevent aspiration, secondary constipation, and occasionally, enteral tube dependency. MBS is considered the gold standard in instrumental assessment of dysphagia; it is used to evaluate severity and guide thickener treatment of DA patients, monitor progress with serial studies, and for re‐evaluation after intervention when appropriate. Previous evaluation of patients with deep interarytenoid notch given laryngoplasty injection included patients with improvement in symptoms despite post‐intervention MBS scores worsening, and vice versa, challenging the use of MBS as a longitudinal tool in clinical evaluation of patients with dysphagia and aspiration. Is MBS severity score reflective of clinical symptoms in pediatric patients with dysphagia and aspiration? A clinical questionnaire of DA symptoms was developed with input from the ADC physicians. The questionnaire was administered over 3 months to patients aged 1‐3 years who had an MBS evaluation within 6 months of their initial ADC visit, standard of care for patients with DA. 17 symptoms (12 GI and 5 pulmonary) were given a numerical score 0‐4 based on parent recall of frequency. MBS was scored 1‐10 on the thickness of liquid recommended for aspiration prevention. Individual symptoms and symptom sets (total questionnaire score, GI score, pulmonary score) were compared to MBS score using linear regression model. 30 patients were surveyed with median MBS score of 6 and range from 0 to 8. 18 patients had an MBS score above 6. Median questionnaire score was 18, with a range from 4 to 53. All analysis showed no significant correlation between individual symptoms or symptom sets and MBS score; the highest R2 value for any individual symptoms was 0.05. Among ADC patients with DA, MBS severity score did not correlate with severity or specificity of symptoms, questioning the use of MBS as a tool for diagnosing severity of persistent DA or as a repetitive tool in assessing response to laryngeal cleft surgical interventions and thickener wean therapy. These findings challenge the use of repetitive MBS in the ADC patient population. Our ultimate goal is to develop a combined clinical and radiologic tool that would minimize radiation exposure and unnecessary thickener treatment while promoting best clinical outcomes.

There is a dearth of validated neonatal feeding assessment instruments available for use in clinical practice in resource-constrained developing contexts. The Neonatal Feeding Assessment Scale (NFAS) was developed to identify and diagnose oropharyngeal dysphagia (OPD) in neonates. The main aim of the study was to develop and test the psychometric performance of a clinical assessment scale for the early identification and diagnosis of OPD in the high-risk neonatal population in South Africa. To meet the main aim, the research project was divided into three separate studies. The research design across the three studies was an exploratory sequential mixedmethod design. The NFAS was developed using the Delphi method in the first study. Two international and three South African speech-language therapists (SLTs) formed the expert panel that participated in two rounds of electronic questioning to develop the instrument. For the second and third studies, a comparative crosssectional within-subject design was used. In the second study the participants were 20 neonates with a median age of 35.0 weeks gestational age (GA) in a 29-bed neonatal intensive care unit (NICU). In the third study 48 participants with a median age of 35.5 weeks GA were included. During the second study the preliminary psychometric performance of the NFAS was determined and in the third study, the final psychometric properties of the NFAS were determined to describe the validity and reliability of the NFAS. The NFAS was developed and approved, using expert collaboration through the Delphi method in the first study. All participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the highrisk neonatal population. The initial NFAS consisted of 240 items across 8 sections; after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to identify the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the final format of the NFAS. The second study showed that 9 out of 20 participants presented with OPD on the NFAS. Comparison of NFAS results with modified barium swallow studies (MBSS). indicated that all participants with OPD were correctly identified (100% specificity). The sensitivity was 78.6%, indicating that three participants were falsely identified with OPD on the NFAS. The instrument took approximately 30 minutes to complete during observation of a habitual feeding session with the mother. Inter-rater reliability was determined on 50% (n=10) of the study sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the NFAS and on the diagnostic outcome of the scale. The preliminary performance of the NFAS appeared to be promising. The formal validation process of the NFAS then followed on a larger sample in the third study. Results of the third study indicated that 15 of the 48 participants were identified with OPD on the NFAS, whereas 14 of these 15 infants were diagnosed on MBSS. A sensitivity score of 78.6% was obtained, with specificity determined to be 88.2% for the newly developed NFAS. The subsequent accuracy of the NFAS to identify OPD correctly was 85.4% when compared with the MBSS outcome. Inter-rater reliability was determined using 35% of the sample. The agreement on overall instrument outcome between the two raters was considered substantial beyond chance, with Cohen's Kappa at 0.598, with an asymptotic standard error of 0.211. The scale may be of use to SLTs working without MBSS equipment and to reach underserved preterm neonates. Inexperienced SLTs may benefit from observational prompts provided by the NFAS. The NFAS may be suitable for use in South Africa and similar developing contexts to identify and diagnose high-risk neonates with OPD.
Thesis (DPhil)--University of Pretoria, 2016.
Speech-Language Pathology and Audiology
DPhil
Unrestricted

Aims: The aims of this research were to describe the signs and symptoms of dysphagia in people who are living with HIV/AIDS and to see what participant variables such as CD4 count, age and diagnosis affect dysphagia. Methods: This study was a descriptive, cross-sectional, quasi non-experimental design. The sampling method that was used for this research was non-probability and convenient. These patients were referred to the speech therapy and audiology department from various multidisciplinary team members for dysphagia assessments. There were 106 participants in total. Eighty participants underwent only a clinical bedside assessment and 26 underwent a bedside assessment as well as a modified barium swallow. The Mann Assessment of Swallowing Ability (MASA) was used to conduct the clinical bedside assessments and a modified barium swallow (MBS) was used as an objective measure. The data was analysed using both descriptive and inferential statistics. These tests included the Wilcoxon signed rank test, Spearman Rho test, Kruskal-Wallis and Mann Whitney U-test. Results: Descriptively, the results revealed that participants with neurological conditions appeared to present with more severe signs and symptoms of dysphagia. The results from the Wilcoxon signed rank test showed that participants with a neurological disorder experienced more severe signs and symptoms of dysphagia, except with laryngeal elevation. The Wilcoxon signed rank test also showed that older participants experienced more dysarthria and oral transit difficulties. The results from the Kruskal-Wallis test highlighted that participants with a lower CD4 count had more significant respiration and voice difficulties. The results from the Mann-Whitney U test showed that participants who were on a HAART regimen experienced increased difficulty in the pharyngeal phase and aspirated more frequently. The Spearman-Rho test results showed that the MASA was seen as a valid bedside assessment tool for assessing adult dysphagia in an acute hospital setting. Discussions: Dysphagia does occur in the HIV/AIDS population in South Africa in participants who have neurological conditions as well as opportunistic infections. The SLP needs to play a key role in the assessment and management of these patients. The MASA is a good assessment tool to use in settings where objective measures are not available.