Evaluation of Patients with Swallowing Difficulties by Modified Barium Swallow

Introduction: 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.Current research was done to study the various phases of swallowing in patients with dysphagia by modified barium swallow with risk of aspiration during swallowing and to study the effectiveness of swallowing manouveres by the modified barium swallow technique Material 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 video fluoroscopic findings, 28 patients have pharyngeal retention alone with no other structural abnormalities.We focused 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.Conclusion: Modified Barium Swallow plays a critical role in the evaluation of swallowing and it provides extensive information about the swallowing events.Mild and moderate pharyngeal retention should be considered as normal in older individuals provided other causes are ruled out.