29/04/2026
videofluoroscopic swallowing study / modified barium swallow.
It is a radiological test where the patient swallows barium mixed food/liquid, and X-ray video records the movement of bolus through the oral cavity, pharynx, larynx, and upper esophagus.
Main use
To assess dysphagia and risk of aspiration.
What it shows
Oral phase: chewing, bolus control
Pharyngeal phase: swallow trigger, residue
Laryngeal protection: pe*******on or aspiration
Cricopharyngeal opening
Upper esophageal passage
Indications
Difficulty swallowing
Coughing/choking during food
Suspected aspiration
Stroke or neurological dysphagia
Post head & neck surgery/radiotherapy dysphagia
Recurrent chest infection due to aspiration
Findings
Pe*******on: food enters laryngeal vestibule but not below vocal cords
Aspiration: food/liquid passes below vocal cords into trachea
Pooling in vallecula/pyriform sinus
Delayed swallow reflex
Cricopharyngeal dysfunction
Nasal regurgitation
Advantages
Dynamic real-time test
Shows all swallowing phases
Detects silent aspiration
Helps plan diet modification and swallowing therapy
Disadvantages
Radiation exposure
Needs barium
Not ideal for repeated frequent testing
Less direct mucosal detail than endoscopy
ENT importance
Videofluoroscopy helps decide:
Safe food consistency
Need for swallowing therapy
Aspiration precautions
Feeding route: oral feeding vs NG/Ryle’s tube vs PEG
