Path to Dysphagia Diagnosis

Tools for Evaluating the Swallow

Tests that further evaluate the upper portion of the swallow are the Modified Barium Swallow (involves eating and drinking foods and liquid with barium in it and then the swallowing process is visible on an X-ray) and the Fiberoptic Endoscopic Evaluation of Swallowing also called a FEES (a lighted scope is inserted through the nose, and then the swallowing of foods and liquids is viewed on a monitor).


Modified Barium Swallow (MBS) is known as the “gold standard” because of its visualization capabilities - Asha


The Modified Barium Swallow (MBS) is known as the “gold standard” because visualization is better for:

  1. Mastication

  2. Tongue propulsion at the onset of the swallow

  3. Arytenoid contact to epiglottis during the swallow

  4. Completeness of epiglottic retro flexion during the swallow

  5. Hyoid and laryngeal elevation

  6. UES opening

  7. Airway closure at the level of arytenoids to epiglottal contact

  8. Aspiration during height of swallow

  9. Esophageal clearance during the esophageal sweep




Fiberoptic Endoscopic Evaluation of Swallowing (FEES) can be also be performed to assess:

  1. Fatigue with meals

  2. Coordination of respiration

  3. Decreased secretion management

  4. Compensatory strategy biofeedback

However, there are some contraindications of FEES:

  1. Severe agitation, inability to cooperate with the examination

  2. Cardiac disorder

  3. History of vasovagal episodes or fainting

  4. Severe movement disorders (dyskinesia)

  5. Severe bleeding disorders and/or recent epistaxis (nosebleed)

  6. History of recent trauma to the nasal cavity or surrounding structures

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