- Dysphagia: What Happens During a Bedside Swallow Exam
- Why might I need a bedside swallow exam for dysphagia?
- What are the risks for a bedside swallow exam for dysphagia?
- How do I prepare for a bedside swallow exam for dysphagia?
- What happens during a bedside swallow exam for dysphagia?
- What happens after a bedside swallow exam for dysphagia?
- Next steps
- Swallowing Disorders
- Types of Swallowing Disorders
- Symptoms of Swallowing Disorders
- Diagnosis of Swallowing Disorders at Johns Hopkins
- Diagnostic Procedures for Swallowing Disorders
- Barium Esophagram
- Esophageal Manometry
- Wireless pH Testing
- 24-Hour pH Impedance
- Treatment of Swallowing Disorders at Johns Hopkins
Dysphagia: What Happens During a Bedside Swallow Exam
A bedside swallow exam is a test to see if you might have dysphagia. When you have dysphagia, you have trouble swallowing. Dysphagia can sometimes lead to serious problems.
When you swallow, food passes through your mouth and into a part of your throat called the pharynx. From there, it travels through a long tube called the esophagus. It then enters your stomach. This movement is made possible by a series of actions from your muscles in these areas. If you have dysphagia, the muscles don’t work properly. You may not be able to swallow normally.
When you breathe, air also enters your mouth and pharynx. From there, it travels to your lungs. Normally, a flap called the epiglottis blocks food particles and liquid from going into your lungs.
If something does enter your lungs, it’s called aspiration. You are much more ly to aspirate if you have dysphagia. Aspiration is a serious problem.
It can lead to pneumonia and other complications.
During a bedside swallow exam, your healthcare provider will assess your risk for dysphagia and aspiration. The test can be performed in your hospital room. It doesn’t need any special equipment. You will first be asked about your symptoms. You will also have a physical exam of the muscles used to swallow. You will then be tested on your ability to swallow different substances.
Why might I need a bedside swallow exam for dysphagia?
If you have dysphagia, aspiration is always a risk. So dysphagia needs to be identified quickly. Various health problems can lead to it. Some examples are:
- Major dental problems
- Conditions that decrease saliva (such as Sjogren syndrome)
- Mouth sores
- Parkinson disease or other neurologic conditions
- Muscular dystrophies
- Blockage in the esophagus (such as from cancer)
You may need a bedside swallow exam if you are having any of the following symptoms:
- Food sticking in your throat
- Difficulty or pain while swallowing
- Certain breathing problems
You may also need this exam if you have a medical condition that puts you at high risk for dysphagia. One example is if you have had a stroke. You may need the test even if you don’t have any symptoms of dysphagia. You may still be at risk for aspiration.
What are the risks for a bedside swallow exam for dysphagia?
A bedside swallow exam is safe. There is a slight risk that you might aspirate during it. This might lead to problems. But your speech-language pathologist (SLP) will try to prevent that.
The SLP typically begins the exam with the substances that are the easiest to swallow. He or she might stop at that part of the exam if you show signs of dysphagia and aspiration. If you have a very high risk of aspiration from dysphagia, you might not swallow anything as part of your exam.
Ask your healthcare provider if the exam presents any other risks for you. Follow-up tests to the exam may have risks, too.
How do I prepare for a bedside swallow exam for dysphagia?
You don’t need to do much to prepare for a bedside swallow exam. You might be told to not eat or drink anything beforehand. You may also want to make a list of your swallowing problems ahead of time. Then you can remember to share them with your SLP.
What happens during a bedside swallow exam for dysphagia?
An SLP most often performs the bedside swallow exam. The SLP checks for signs of dysphagia and aspiration throughout the exam.
First, your SLP may ask you questions about the following:
- The nature of your swallowing problems, such as food sticking in your throat or pain while swallowing
- The substances that usually cause these problems
- Frequency, severity, and onset of these symptoms
- Other symptoms that might be related to dysphagia, heartburn or coughing when eating
- Your medical history
If possible, the SLP may also talk with your family members. The SLP may ask them about what foods you find hard to swallow and what foods you tend to avoid.
During the exam, the SLP will carefully evaluate your teeth, lips, jaws, tongue, cheeks, and soft palate. You may need to perform certain movements, smacking your lips together or sticking out your jaw. You may also need to make certain sounds, cough, or clear your throat. The SLP may check your reflexes for gagging and coughing.
You will ly be asked to swallow a series of substances. They may range from water, thicker liquids, pureed foods, soft foods, and even regular foods. The SLP will note whether you have problems chewing, swallowing, or breathing. He or she will also check if your voice sounds “wet.” That can be a sign of aspiration.
What happens after a bedside swallow exam for dysphagia?
Many people need to stay in the hospital after their bedside swallow exam. They usually need treatment for other medical problems. If you have the exam while visiting your healthcare provider, you will ly be able to go home right after it. You will usually find out about the results right away. If you don’t have any problems with swallowing, you may be able to eat normally again.
You may need follow-up tests if your medical team is still worried that you might have dysphagia. These tests can help identify dysphagia, even if you don’t have any symptoms. Sometimes they can also help pinpoint the source of a swallowing problem. These tests may include:
- Modified barium swallow test (MBS) to visually show if material is traveling into your lungs
- Fiberoptic endoscopic evaluation of swallowing (FEES) as an alternative to the MBS
- Pharyngeal manometry to check the pressure inside your esophagus
You may need treatment if the bedside swallow exam or other tests show that you have dysphagia. In some cases, your medical team may be able to address what is causing your dysphagia. Surgery is one possible treatment.
Whatever the cause of your dysphagia, you will need to take precautions to prevent aspiration. You may need to modify your diet.
For instance, you may need to drink only liquids of a certain consistency, or drink no liquids at all. You may also need to modify your position while you eat.
You may learn special mouth exercises and techniques to help you swallow. If your swallowing is very poor, you may need to use a feeding tube for a short period of time.
How long it takes you to recover from dysphagia depends on its severity and cause. It’s important for you to work closely with your healthcare team for the best treatment.
If you are moving to another facility or going home, follow your healthcare provider’s guidelines closely. They can help reduce your chance of aspiration and other medical problems.
Only make changes to your diet after talking with your healthcare provider.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
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Swallowing is a set of coordinated muscle movements that control the mouth, the back of the throat (pharynx) and the food tube (esophagus). Swallowing occurs without us even thinking about it, yet it is a complex and vital function, as it is very important to eating and social interaction.
Types of Swallowing Disorders
Trouble with swallowing refers to two problems:
- Dysphagia — the sensation of food or fluid being regurgitated or stuck in the chest; also any throat discoordination leading to coughing or choking during swallowing
- Odynophagia — pain in throat or chest during swallowing
Swallowing disorders may result from a lack of coordination of the nerves or muscles, or sometimes from infections and tumors.
Symptoms of Swallowing Disorders
Swallowing disorders result in a number of troubling symptoms.
If you have trouble swallowing, you may have just one problem ( pain with swallowing) or you may experience a few different problems ( difficulty when starting to swallow and then coughing during the swallow).
Since some swallowing disorders may be serious, it is important to get a proper diagnosis. Johns Hopkins gastroenterologists can quickly and accurately diagnose any swallowing disorder you may have.
Symptoms of swallowing disorders include:
- Dysphagia — a sense of food “sticking” on the way down and difficulty passing food or liquid from the mouth to the esophagus to the stomach
- Coughing during or immediately after swallowing
- Choking — a feeling of food or liquid sticking in the throat or esophagus followed by coughing
- Regurgitation — the return of food or liquid back to the mouth or pharynx after it successfully passed. This happens effortlessly, un vomiting, which involves contraction of abdominal muscles. If the regurgitation tastes ingested food, it usually indicates a swallowing disorder; if it tastes sour or bitter, that indicates it reached the stomach and it is more ly gastroesophageal reflux disease (GERD).
- Nasal regurgitation — when food or fluid comes up into the nose; this occurs when the nasopharynx does not close properly
Other symptoms may include:
- Sore throat
- Shortness of breath
- Chest discomfort or pain
It can be hard to match up symptoms to a specific disorder on your own. An experienced gastroenterologist is specially trained to help diagnose all types of swallowing disorders. It is important to make an appointment with a gastroenterologist if you are having any of these symptoms.
Diagnosis of Swallowing Disorders at Johns Hopkins
At Johns Hopkins, we combine the latest diagnostic equipment with the expertise of the nation's top gastroenterologists. Our physicians have years of experiencing diagnosing and treating even the most challenging swallowing disorders. Our high volume of cases means we have the necessary experience and capability to diagnose your condition quickly and accurately.
Diagnosing and treating swallowing disorders requires a multidisciplinary team approach. There are many specialties involved in evaluating and managing swallowing disorders. Your gastroenterologist is at the heart of the diagnostic team, directing care and guiding patients through the appropriate procedures. Other members of your team may include:
- Motility specialists
- Ear, nose and throat physicians
- Speech therapists
Diagnostic Procedures for Swallowing Disorders
Your doctor will begin with a thorough physical examination and will ask you about your medical history. It may be helpful to write down when you have your symptoms, whether any foods in particular aggravate your symptoms and when you think the trouble started, and bring this list to your appointment.
Your history of symptoms will help your doctor determine the type of disorder you may have and the tests necessary to determine the cause.
Diagnostic procedures your doctor may order include:
Gastroenterologists at Johns Hopkins routinely perform endoscopies, a frequently used diagnostic procedure for swallowing disorders. Their vast experience with these tools allows for an accurate diagnosis.
Your doctor may perform an endoscopy to examine the esophagus and stomach. An endoscope is a thin, lighted tube with a camera at its tip that allows your doctor a better view of your condition.
During an endoscopy:
- You are sedated.
- Your doctor inserts a flexible endoscope through your mouth and into your esophagus.
- The endoscope allows your doctor to examine your stomach, duodenum (the first part of your small intestine) and esophagus.
- Your doctor looks for tumors, esophageal strictures (narrowing) and abnormalities in the mucous lining.
- If necessary, your doctor can perform a biopsy, removing abnormal tissue for further analysis.
Our doctors have decades of experience performing barium esophagrams, one of the most important diagnostic procedures for swallowing disorders.
Barium X-ray studies are often the first step in diagnosing swallowing disorders. This procedure allows your doctor to evaluate your entire swallowing channel, which includes the mouth, pharynx and esophagus. This provides a better view of both the structure and function of the swallowing channel, and offers a contrast so abnormalities show up on the X-ray.
During barium esophagram:
- You swallow liquid called barium, which shows up on X-rays in bright contrasts to the other structures.
- The barium coats your gastrointestinal tract, making it easier for the doctor to see the structures and detect abnormalities.
- An X-ray is performed — sometimes a single X-ray and other times a sequence of X-rays, which make a kind of movie to better capture how your swallowing channel works.
- The X-ray pictures are stored for your doctor to evaluate.
An esophageal manometry evaluates the changes in pressure that happen when you swallow.
During an esophageal manometry:
- Your nurse will pass a thin, flexible catheter through your nose or mouth, down your throat and into your stomach. While it can be slightly uncomfortable to have a tube in your nose, the test only lasts about 10 minutes.
- Attached to the tube are a number of pressure sensors.
- Using the pressure sensors, your doctor can assess the recording of your swallowing muscles in action.
- You start by swallowing a few sips of water.
- You may bring foods that trigger your symptoms; this way, your doctor can see what is happening in real time.
Esophageal manometry provides your doctor with real-time information about:
- Strength and coordination of the muscle movements (peristalsis) of the pharynx and esophagus.
- Strength and relaxation function of the upper and lower esophageal sphincters. A sphincter is a muscle that opens and closes; the lower esophageal sphincter is the muscle that controls the emptying of foods from the esophagus to the stomach.
Wireless pH Testing
Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period, while you are continuing your normal activities. To perform wireless pH testing:
- Your doctor performs an endoscopy and places a small chip in the lower esophagus.
- The chip records acid at that site for 48 hours. A newer version allows for 96 hours of recording when recommended by your doctor.
- The chip transmits your acid level to a wireless recording device that you wear on a belt.
- The recording device is sent to your doctor who downloads the data and can gauge your reflux severity.
24-Hour pH Impedance
Your doctor may order this procedure to evaluate your reflux. During pH impedance:
- Your nurse places a thin, flexible catheter with an acid-sensitive tip through your nose into your esophagus. The catheter is placed in separate recording spots to evaluate the flow of liquid from your stomach into your esophagus.
- The catheter stays in your nose for a period of 24 hours.
- Your doctor is able to evaluate the recordings to see whether you have GERD, the severity of your reflux and the correlation between your reflux and symptoms, along with the presence of nonacid reflux.
Most people have some reflux on a daily basis, but your doctor is looking for an excessive amount of reflux.
Treatment of Swallowing Disorders at Johns Hopkins
Swallowing disorders encompass a wide variety of conditions and causes, so treatment for a swallowing disorder needs to be individualized.
Your doctor will create a treatment plan the severity of your symptoms and how they affect your quality of life. Learn more about treatment for swallowing disorders at Johns Hopkins.