Modified Barium Swallow and Dysphagia Studies

It took me quite a few modified swallow studies with the Speech Therapist in order to visually witness what they were looking for.  This clip (played three times) shows exactly what they are looking for:

A modified barium swallow is typically performed because patients are having difficulty swallowing, and may be choking on food or drink. If it goes into the lungs, we call it aspiration. The Therapist will mix barium with different consistencies of food; usually they can use thin barium to replicate drinking, and they might mix a past or barium powder with continually thicker substances so that we can visualize the food on the fluoro monitor. I have seen nectar, applesauce, tuna salad, cookies, crackers etc. Depending on which textures the patient reacts to, the Therapist can designate a particular type of diet to lower the risk of aspiration, and further visits to the hospital.

This video shows aspiration - I allowed it to play twice before adding an arrow pointing out the aspiration on the third loop. Watch the patient finish chewing... observe the black bolus travel from the oropharynx, down to the laryngopharynx, then the epiglottis closes off the trachea. The majority of the bolus travels down the esophagus (parallel to the spine, but posterior to the trachea). The arrow indicates a small amount of contrast getting around the epiglottis and dripping down the trachea. Notice that the patient does not seem to have a cough reflex, which is not quite as common.