Dysphagia can be screened, assessed or diagnosed in a number of different ways.
Below are some of the common ways that a healthcare professional may test for dysphagia. Keep in mind that the process used to assess your swallowing problems may vary depending on the healthcare professional you visit.
Testing for dysphagia may include both instrumental and non-instrumental methods, meaning they may or may not use special tools to check your swallowing.
Non-instrumental methods to assess for dysphagia
Commonly, a healthcare professional, such as a speech-language pathologist, dietitian or occupational therapist, may start by checking your medical history, including any past problems with swallowing or history of conditions that may lead to difficulties with swallowing.
Once the healthcare professional understands your medical history, they will often conduct physical and visual examinations. In a typical situation, your healthcare professional may ask you about your mental status, nutritional status, and your respiratory health. They may ask you to open and close your mouth, simulate a cough or move your lips or tongue in a certain way to check for your overall control of oral muscles and nerve function. They may also listen to the way you speak for any warning signs, such as gurgly voice caused by saliva entering the airway.
Your healthcare professional may give you a range of different liquids or foods to swallow, in varying amounts and thicknesses, to check your ability to swallow safely and efficiently. Not all food and drink items are swallowed the same way. You might have a problem with one consistency and no problems with anything else.
Instrumental examinations for dysphagia
In-depth examinations using clinical instruments may be performed by healthcare professionals with a more specialized knowledge of dysphagia. Typically, these tests go much deeper than non-instrumental tests and are used to explore a person’s swallowing symptoms in detail beyond simply checking for signs of aspiration.
Videofluoroscopic Swallowing Study (VFSS)
Also known as Modified Barium Swallow Study, is a widely-used instrumental examination method used to assess swallowing difficulties. It uses x-ray video to look at how you swallow, how well your swallowing is working, and where things may be going wrong. A swallow specialist uses this test to make sure that food or drink is not going down the wrong way, and is not being left behind in the mouth or throat after the swallow. These are things that cannot be determined through a non-instrumental method of assessment. In this test, you will be asked to eat a range of foods and drinks mixed with barium. The kind of barium used in swallow studies is white powder that is safe for most people, and the purpose of the barium is to clearly see where the food or liquid is in your mouth and throat during a swallow because barium can be seen on x-rays. This way, your healthcare professional can see how your swallow works in real swallowing situations. An appointment for this test normally takes about up to an hour from start to finish, and during this time you may be under the x-ray for about 5 minutes. You might notice that your stool turns white after a barium swallow study. This is normal. Ask your healthcare professional for additional details about this test, such as any risk factors associated with any other conditions you may have, such as pregnancy, or whether this test may be right for you.
Flexible Endoscopic Evaluation of Swallowing (FEES)
An alternative test to VFSS to look at swallowing function. This procedure involves a small endoscope (a thin, long tube with a camera at the end) being inserted into your throat through your nose. The camera is then used to help a swallow specialist watch your swallowing function. Similar to VFSS, you will be asked to swallow various foods and drinks while your healthcare professional watches the camera. Typically, this procedure is not painful, and your healthcare professional will apply lubrication, sometimes containing numbing agents, to minimize discomfort in your nostrils. This test is often performed at an ear, nose, and throat doctor’s office. Other swallowing specialists also perform this test. The procedure itself should only take a few minutes. Following either type of instrumental procedure, your swallow specialist should take time to view the results and discuss recommendations with you.