Today I had the opportunity of observing a modified barium swallow study on one of my patients. A modified barium swallow is a type of procedure used to investigate the coordination of muscles and structures in the mouth and throat. The purpose of this study is to identify patients who are at risk for aspiration (when matter enters the lungs). It also serves as a tool for identifying safe food/liquid consistencies for patients to consume.
How it works:
- Barium sulfate, an opaque substance when viewed by X-ray, is added to liquids of different consistencies
- Types of liquid consistencies:
- Thin – non-restrictive
- Nectar – some liquids require thickening, consistency is most similar to tomato juice
- Honey – all liquids require thickening, liquids become very slow to pour
- Pudding – liquids must be spooned
- The patient sits or stands in front of a fluoroscopy machine (X-ray) while swallowing the prepared liquids
- Fluoroscopic images are taken simultaneously, capturing the bolus as it travels from the oral to the pharyngeal phase
- The speech language pathologist views the fluoroscopic images and can then determine the safest consistency for the patient
Unfortunately, my patient suffered from silent aspiration, meaning her epiglottis was delayed in blocking the trachea (passageway to the lungs), allowing thin liquids to enter into her lungs. Nectar thick liquids however did not cause her to aspirate so for the time being, her nutritional needs must be met entirely by a nectar thickened liquid diet, and that’s where the dietitian’s job begins!
If you want to see a barium swallow check out this short clip.