Videofluoroscopic swallow study: techniques, signs and reports

Management of oropharyngeal swallowing dysfunction often requires both a clinical and an instrumental examination. A videofluoroscopic swallowing study is an instrumental examination that often could be a good option and a very useful tool for the swallowing clinician. At Skåne University Hospital, Malmö, Sweden, the name of such examination is therapeutic videoradiographic swallowing study (TVSS). A TVSS examination should always be performed in collaboration between a speech language pathologist and a radiologist. During the examination, the patient is seated in an upright position, but the examination can also be performed with the patient lying down. The TVSS examination can be performed both in frontal and lateral projection. Test material with varied consistencies as well as different therapeutic strategies can be tested during the examination. Any oral and/or pharyngeal dysfunction can be defined, for example a delay in the initiation of the pharyngeal swallow or an absent pharyngeal swallow, pharyngeal retention, penetration, and silent aspiration. After the examination, an analysis is performed, and it is studied how different textures affect the physiology of swallowing. A report is then written in which the actual dysfunction is described in detail, and recommendations regarding modified textures and swallowing techniques are given.