Barium sulphate coating of the nasopharynx in lateral view videofluoroscopy

There is disagreement regarding the usefulness of barium nasopharyngeal coating for clinical velopharyngeal evaluation. One hundred and thirty lateral videofluoroscopic studies performed both with and without barium at the same sitting were reviewed to evaluate multiple structural and functional characteristics of velopharyngeal valving behavior during speech production. Clinical ratings of hypernasality were also available for 105 of the patients studied by x-ray. Agreement between ratings of hypernasality and radiographic evidence of VP incompetency did not differ with respect to the presence or absence of barium. However, velopharyngeal incompetence was generally judged to be greater when the barium coating was used. The barium coating also provided more information as to the presence or absence of Passavant's ridge, generalized posterior pharyngeal wall movement, and palatal asymmetry. However, because the barium may produce artifacts or occasionally obscure structures, we recommend that lateral videofluoroscopy be performed both with and without barium.