Clinical evaluation of dysphagia typically begins with a non-instrumental clinical examination. This initial evaluation will include a careful review of the patient’s history, evaluation of the strength, range of motion and coordination of the muscles involved in swallowing, and may entail observation of the patient eating and drinking.
In addition, instrumental assessment of swallowing (Videofluoroscopic Swallow Study and/or Fiberoptic Endoscopic Evaluation of Swallowing) is/are required to complete the oro-pharyngeal swallowing disorders management.
The videofluoroscopic swallowing study (VFSS) is a dynamic radiographic study. The examination images oral, pharyngeal, and cervical-esophageal bolus flow during swallowing. Anatomic and/or physiologic abnormalities are identified relative to swallowing. During the study, the effects of modifications in bolus size, bolus texture, patient positioning, compensatory maneuvers, and sensory enhancement techniques on bolus flow are evaluated to determine optimum swallow safety and efficiency.
In addition, using of Fiberoptic Endoscopic for Evaluation of Swallowing (FEES) instrumentation allows inspection of functions of the swallowing mechanism at the velopharynx, oropharynx, pharynx, and larynx. Endoscopic assessment of swallowing function is not a screening examination but a comprehensive assessment of the upper aerodigestive functions of swallowing. It includes five components:
1) Assessment of anatomy involved in the pharyngeal stage of swallowing
2) Assessment of movement and sensation of critical structures within the pharynx,
3) Assessment of secretions
4) Direct assessment of swallowing function for food and liquid, and response to therapeutic maneuvers and interventions to improve the swallow
The purpose of these procedures is the comprehensive evaluation of the swallowing phases to obtain a detailed analysis of the patient’s oropharyngeal swallowing mechanism, correlate these findings with the patient’s dysphagia symptoms. Consequently, the physician will approach care of plan and recommendations regarding the adequacy of the swallow, the advisability of oral feeding, and the use of appropriate interventions to facilitate safe and efficient swallowing.