Dysphagia can be diagnosed and monitored with many different screening tools. Common to all these screening tools is the ability to differentiate patients at risk for aspiration and laryngeal penetration from those who can consume solids and/or liquids safely (Papadopolou 2013). One of the most common and initial forms of screening for dysphagia is the Bedside Swallowing Evaluation (BSE). The BSE is important in helping clinicians decide the degree of safety in oral feeding, and foresee warnings about potential complications. The BSE allows speech-language pathologists to conduct a case history interview about the patient’s nutritional and respiratory medical status, and an examination of oral motor abilities including labial, palatal, lingual, pharyngeal wall, and laryngeal muscle control; along with an assessment of swallowing (Workman and Treole, 2002). Patients are diagnosed with dysphagia if the speech language pathologist performing the BSE observes signs of aspiration, such as coughing, choking, or liquid and/or food present in or around the tracheostomy stoma, limited or uncoordinated laryngeal movement, or a wet sound in vocal quality after drinking (Shem et al. 2012).
Videofluoroscopic Swallow Studies (VFSS) are considered to be the gold standard for evaluation of oropharyngeal dysphagia as it provides direct visualisation of the movement of the jaw, palate, pharynx, larynx, esophagus and tongue during the swallowing motion (Shem et al. 2012b). Videofluroscopy works by ingestion of different types of foods ranging from very liquid to solid made radiopaque with a small dose of barium sulfate, via syringe or spoon in order to measure muscle movements during swallowing (Ryu et al. 2012). Not only can it be used to diagnose the existence of dysphagia in a patient, it can also be used to determine the etiology of dysphagia and under what conditions the patient can swallow safely (Shem et al. 2012b). Dysphagia is diagnosed if a patient undergoing the VFSS presents with any of the following: pooling of the test material in pyriform sinuses/valleculae, decreased laryngeal elevation, lack of epiglottic inversion, laryngeal penetration and aspiration (Shem et al. 2012b). Not only does this assessment require specially-trained technicians, but patients who are in intensive care, unable to sit in the correct position, or those with a high risk of aspiration may not be suitable to undergo VFSS (Papadopoulou et al. 2013).
The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a widely used diagnostic procedure in exploring the swallowing process when patients are not suitable for VFSS. It is performed using a flexible laryngoscope that is fed through the nasal cavity that allows imaging of the epiglottis, sinus piriformis and arytenoid cartilages; consumption of a bolus (liquid or semi-liquid food) allows for examination of the swallowing reflex and presence of aspiration, retention and laryngeal penetration can be observed (Wolf & Meiners, 2003). FEES can be performed in a sitting eating position, or for bed-ridden patients the head of the bed is raised 45 degrees or more to compensate (Papadopoulou et al. 2013). FEES is well tolerated, administrable to bed-ridden patients, and can be used repeatedly to monitor therapy progress. FEES is disadvantaged in that the oral and esophageal phase of swallowing cannot be examined; additionally, documentation and reporting of FEES can be time-consuming and difficult to complete (Hey et al. 2009).