Diagnostic Approach
The gold-standard for diagnosing oropharyngeal dysphagia in countries of the Commonwealth are via a Modified Barium Swallow Study or Videofluoroscopic Swallow Study (Fluoroscopy). This is a lateral video (and AP in some cases) X-ray that provides objective information on bolus transport, safest consistency of bolus (different consistencies including honey, nectar, thin, pudding, puree, regular), and possible head positioning and/or maneuvers that may facilitate swallow function depending on each individual's anatomy and physiology. This study can be performed by a Speech-Language Pathologist or a clinical nutritionnist (in Canada) and a Radiologist.
In the US and many other places a FEES (fibreoptic endoscopic evaluation of swallowing - sometimes with sensory testing) is done usually by an otolaryngologist (ear nose throat doctor) in conjunction with a speech therapist knowledgeable in the field of swallowing. This procedure involves the patient eating different consistencies as above administered usually by the speech therapist while the doctor performs a transnasal fiberoptic laryngoscopy with a thin flexible tube attached to a light source and to a camera so the exam can be recorded for further analysis.
Chest X-ray: to exclude bronchial carcinoma.
OGD: direct inspection and biopsy to look for any mass or ulceration.
Barium swallow and meal: look at mucosal lining and detect achalasia.
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