Diagnosis of dysphagia is done by speech-language pathologists, often with the help of medical doctors like oto-laryngologists and radiologists. Diagnosis comes after thorough examination of many factors. This complete examination usually has several parts and may be done on several days.
A dysphagia examination must include a thorough case history and an assessment of the structures involved in swallowing as well as their function. A case history is the part of the examination where you are asked specific questions about the problem and about many related issues, including past swallowing problems, your current medications, and associated medical conditions. Also, examination of your lips, teeth, jaw, tongue, pharynx and other parts of your body involved in swallowing is done to make sure that none of these parts is broken, is out of place, has been removed (maybe because of a surgery), or is not working correctly. An examination of how your (swallowing) muscles move and work is also done to make sure they are not weak or there is no other problem with them. As part of this examination you may be asked to taste different flavors, drink and eat small amounts of food and liquid, and to learn/practice potential swallowing maneuvers.
The Voice and Swallowing Institute has speech language pathologists with up-to-date and specialized training in diagnosing and treating dysphagia in adults and children
Examination may also include different tests that involves technical machines. Three common tests like this are:
- Video-fluouroscopic swallow studies
- Flexible endoscopic swallow studies
- Fiber-endoscopic evaluation of swallowing with sensory testing
The Voice and Swallowing Institute offers all 3 of these studies.
You are asked to eat and drink a variety of things during each of the studies. Some of this may be combined with special substances, like green food coloring or barium, to make it easier to watch what is happening as you swallow. At the same time the speech-language pathologist and oto-laryngologist identifies the exact source of the problem, and may also attempt different strategies to help you swallow better and more safely. Strategies include evaluating different food consistencies and liquids of varying thicknesses, as well as maneuvers, that may help improve how well and safely we swallow. The names of some of these maneuvers are the chin tuck and Mendelsohn maneuvers. They will be discussed further in the treatment section.
Video-fluoroscopic swallow studies are done in the X-ray suites of hospitals. These studies are also called modified barium swallow studies. During this examination you are asked to eat and drink a variety of things while being X-rayed. At the same time the speech-language pathologist attempts to identify the exact source of the problem, and may also attempt different strategies to help you swallow better and more safely. The results of the study help identify where food and liquid get stuck (if they get stuck), if there is a problem with muscle or sensory function, and how well and safely all of the swallowing stages are coordinated. The speech-language pathologist and oto-laryngologist will decide if you are a good candidate for this procedure.
The Voice and Swallowing Institute has specialized equipment for video-fluoroscopic examination of swallowing in children.
Flexible endoscopic swallow studies can be done in a hospital clinic. A flexible endoscope is a machine that consists of a long tube and a camera. During this examination the device is passed through one of your nasal passages to the back of the throat where passage of food and drink can be observed. These studies tell us about what happens before or after the food is actually swallowed. They can help identify if the bolus enters the pharynx early and where things get stuck when they get stuck. These studies may also be applied to therapy situations and are extremely helpful in determining the best and safest food consistencies and liquid thicknesses for a patient to swallow. The speech-language pathologist and oto-laryngologist will decide if you are a good candidate for a flexible endoscopic swallow study.
Fiber-endoscopic evaluation of swallowing with sensory testing (FEESST) can also be done in a hospital clinic. A specialized flexible endoscope is used during this test. During this examination the device is passed through one of your nasal passages to the back of the throat where passage of food and drink can be observed, just like with a flexible endoscopic swallow study. However, the specialized flexible endoscope also allows us to look at the sensory functioning in your throat by giving small puffs of air. Sensory functioning might be altered (changed) for some individuals diagnosed with acid reflux (also known as laryngo-pharyngeal reflux). Like flexible endoscopic swallow studies, these studies tell us about what happens before or after the food is actually swallowed. They can also help identify if the bolus enters the pharynx early and where things get stuck when they get stuck. The speech-language pathologist and oto-laryngologist will decide if you are a good candidate for FEESST.
Following the dysphagia examination, recommendations may be made that could include further consultation with medical specialists, swallowing therapy, changes in or restrictions on what you eat, and other testing that may be useful.