[Dysphagia] Food and barium

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

Chris and Claire Langdon <chris_claire@bigpond.com> wrote:
(Quoting from the Bronwyn Jones text again - she is discussing tailoring the
examination to match the presentation of the patient)

For example, if the clinical evaluation suggests that the patient chokes on
liquids, it may be wise to begin with a small volume of puree or a small
volume of thin liquid thather than a large volume of high density
barium."(page 36).

***Please note that she is talking about using barium. I would also disagree with the rationale presented here. It has no real foundation and is presented as the author's opinion only.

"Remember that patients with a neurological process involving the pharynx
often cannot handle liquids without aspiration and actually may do better
with thicker liquids and/or puree or solids (from the point of view of
aspiration). However, if there is also pharyngeal paresis or decreased or
absent tongue thrust the thicker boluses may result in increasing retention
in the valleculae and piriform sinuses with the potential for overflow
aspiration." (page 45).

***Please note the "may" and "potential for" as there is no real foundation for this.

I'd argue that using solid boluses in VFSS has a place - for example in
evaluating a patient with a "compensated" swallow - where a patient has been
making dietary changes to compensate for a deteriorating swallow ie. avoids
solids and has switched to a pureed diet; and for a patient with a suspected
Zenker's diverticulum.

*** I don't follow the argument about the Zenker . They fill with liquid barium quite easily.

I



Dr I Campbell-Taylor
Clinical Neuroscientist
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