[Dysphagia] VF anterior view

[eripley at yahoo.com (Irene Campbell-Taylor)]

This is one of the things that is difficult to quantify simply because it is taken for granted that AP views are mandatory. Anyone trained with radiologists in VFSS knows this for the simple reason that, if only lateral views are done, it is impossible to tell on which side something is occurring. There are multiple other reasons - unilateral or bilateral failure of epiglottic descent, relative position of vocal cords, presence of pharyngeal pouches etc. the following is from the Johns Hopkins dysphagia Center. Please note that it is also taken for granted that VFSS must be recorded for later viewing and analysis because it is impossible, in real time, to identify all dynamics of the swallow, and that the clinical examination MUST be performed first:


Objective Tests 

The clinical examination, particularly the patient's description of the nature and history of their symptoms, should always be the initial step in the evaluation of swallowing disorders. The patient's self-report often suggests both the type of disorder most likely responsible for the complaints and the objective tests required to determine, or verify, the specific cause. Minor abnormalities of the swallowing mechanism are frequent, especially in older patients. They must not be over-interpreted. The clinical examination offers a check against objective findings and allows for comparison and interpretation.

 

Barium Radiography 

Except when re-evaluating a patient with an established diagnosis, barium x-ray studies are usually the first step in the evaluation of swallowing disorders. These studies permit evaluation of the entire swallowing channel (mouth, pharynx, and esophagus). Even when the location of the abnormality is suggested by the clinical history, barium radiography allows assessment of both the structure and function of the swallowing mechanism. When symptoms suggest an esophageal condition, a standard barium swallow (often performed as part of an upper GI [UGI] series) is generally adequate. However, the flow of barium through the pharynx is too rapid for the radiologist to record important details of swallowing. Therefore, when a pharyngeal condition is suspected, a video-barium study (videopharyngoesophagram, during which the flow of barium through the pharynx and esophagus is recorded on a videotape recorder) is essential.

 

Modified Barium Swallow 

A modified barium swallow is a variant of the video-barium study in which the effect of various maneuvers on the efficiency of swallowing is evaluated. Maneuvers may include modifications in the type of swallowed bolus, in head or body position, and in the timing of swallowing in relationship to respiration. Primarily designed to evaluate the effect of therapeutic maneuvers on patients with established neurological or post surgical disorders of oral and pharyngeal function, the modified barium swallow is sometimes used as the first test in patients in whom these disorders are strongly suspected. However, those who specialize in this procedure (most often speech language pathologists with special training in the field of swallowing) may have limited familiarity with structural disorders of the pharynx and even less with radiological abnormalities of the esophagus. In general, the modified barium swallow should be used only after a detailed diagnostic video-barium study has been
 performed under the supervision of an experienced radiologist, or as a combined study in which the swallowing therapist and radiologist collaborate.

 

The treatment of patients with swallowing disorders should be individualized. The symptoms along with the physical and emotional impact upon quality of life should be assessed and considered in the development of a treatment strategy. To date, relatively small numbers of well-controlled clinical trials have been conducted; therefore, experience, rather than analysis of data, is often the basis for treatment.

 

 

Paula Leslie <Paula.Leslie@newcastle.ac.uk> wrote:
Dear All

On behalf of my colleagues I would like to post this. We all know that AP 
view is important but is there any primary source evidence? I managed to come 
up with one paper on Medline (on cricopharyngeal dysfunction) since 1966 and 
nothing on Pubmed. This was using very simple searches I must admit.

Many thanks for any papers you can point us at.

Paula


The SLTs hold a regular study group on topics in videofluoroscopy. This month 
we were trying to look at the evidence for doing A-P as well as lateral views 
when doing a V/f.

Despite several combinations on a literature search, I have been unable to 
come up with any decent articles for and against the case.

Do you know of any, or is it the case that there isn't much evidence around?

Paula Leslie
Degree Programme Director
Surgical and Reproductive Sciences
Faculty of Medical Sciences
University of Newcastle
Newcastle upon Tyne
NE2 4HH
UK
T +44 (0) 191 222 6279
F +44 (0) 191 222 8988
http://www.ncl.ac.uk/sars/postgrad/MSc.htm

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Dr I Campbell-Taylor
Clinical Neuroscientist
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