Path to Dysphagia Diagnosis
  • Carinda Stout, MS CCC/SLP

What could be addressed after the MBS:

If a person has difficulty with secretion management or has anterior spillage of the bolus, there are probably some labial seal issues; therefore, therapy will address the orbicularis oris and labial seal with resistive labial exercises.


The tongue has to move the bolus from side to side, recollect the bolus and move it posteriorly, pushing up against the palate to create pressure to propel the bolus. If the person has poor bolus formation, residue in the sulci, and/or spillage, bolus formation is likely reduced and they probably have a weak tongue. If there is noted residue on the tongue and/or palate, they probably are not getting enough tongue-palate contact; therefore, therapy will consist of resistive lingual exercises. Pocketing in the lateral sulci will indicate poor buccal strength and decreased tension; therefore, resistive cheek exercises are recommended.


Pharyngeal spillage can indicate the tongue (including the back) is weak and not holding the bolus in a cohesive manner; therefore, it is recommended to initiate resistive lingual exercises, Masako Maneuver, and effortful swallow.

Pharyngeal residue indicates decreased tongue base retraction and most likely decreased pharyngeal stripping wave; therefore, utilize the effortful swallow.



Penetration and/or aspiration can occur from decreased hyolaryngeal excursion, which can be any of the three areas including anterior motion of the hyoid, laryngeal elevation and hyoid/thyroid approximation for laryngeal closure. Therapy can address airway protection through the effortful swallow, lingual strengthening (the tongue is attached to the hyoid, which is part of the excursion), and Mendelsohn Maneuver. Decreased airway protection can also be exhibited through evidence of reduced epiglottic inversion which therapeutic intervention would include effortful swallow with resistance.


Pyriform sinus residue could possibly reveal an issue with the pharyngeal esophageal segment (PES/UES) opening; which is opened through hyolaryngeal excursion and the force of the bolus. The bolus is transferred through the oropharynx by the pressure of the tongue; therefore, exercises could include lingual strengthening, Shaker, effortful swallow and change the bolus size and consistency.


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