Dysphagia 5 - Instrumental Testing Flashcards
Identify the two types of swallowing testing.
Radiographic & non-radiographic
Name the eight types of non-radiographic swallowing tests.
FEES, FEEST Upper GI endoscopy Manometry Ph probe Ultrasound EMG Cervical auscultation
Name the six types of radiographic swallowing tests.
Pharyngoesophagram/Barium Swallow Upper GI series Modified Barium Swallow Scintigraphy (Milk Scan) CT scan MRI
Define FEES.
How is it conducted?
Who conducts a FEES procedure?
Identify the advantages of the FEES procedure.
Disadvantages of FEES?
Fiberoptic endoscopic evaluation of swallowing
Uses a narrow flexible tube inserted into nasal passage to point of the larynx
SLP conducts this procedure
Advantages
Quick
Transportable
Allows visual of residue, pooling, aspiration
Disadvantages
No visual of oral or pharyngeal stages
“white out” phase
Requires training (usu. ENT)
Define FEEST.
T/F - FEEST is NOT associated w/ FEES procedure.
Explain the use of this procedure.
What does it evaluate?
Fiberoptic Endoscopic Sensory Test (FEEST)
False
This procedure uses calibrated puffs of air * delivered to pharynx/larynx (i.e. VF sensitivity testing their cough)
It evaluates presence or absence of vocal folds
Describe the purpose of an Upper GI endoscopy.
Same as FEES except images hypopharynx, esophagus, stomach, and duodenum
GI performs using conscious sedation
Describe the dynamics of using manometry.
Catheter w/sensors into nose to level of UES & LES
Measures esophageal motility, pressures, & coordination
Gives info re: peristalsis
Dry & water swallows done
Describe the dynamics of a Ph Study.
Designed to dx reflux
Tube in nose to LES; in place 24 hours
Determines level of acid in lower esophagus
Less than 4.5 acidic (neutral ph is 7.0)
Describe the dynamics of an ultrasound.
Visual of oral/oral pharyngeal structures
Tongue, floor of mouth, hyoid, larynx (see shadows)
Timing relation between oral and pharyngeal
What are the advantages of using an ultrasound?
Disadvantages of using ultrasound?
Advantages
- Noninvasive, portable, no radiation
- Helps assess oral prep and oral
- Biofeedback
Disadvantages
- Doesn’t detect aspiration
- Difficult to interpret
- It requires highly specialized training
What does EMG stand for?
What does it examine?
What does an EGG measure?
Electromyography
Evaluates electrical activity in muscle, muscle contraction
Measures movement of vocal folds during phonation
What does MBS stand for?
What does VFSS stand for?
Modified barium swallow study (MBS)
Videofluorographic swallow study (VFSS)
Identify the goals of conducting a MBS.
Evaluates oral, pharyngeal, & early esophageal structures
Assess swallowing of various materials
Patient’s reaction to secretions (silent aspiration)
Adequacy of airway protection
Impact of compensatory therapy maneuvers
What are the indications for a MBS?
Review 10-1
Review MBS procedures
10-1
10-2
10-5
What checklist is used during a MBS observation?
Describe the actions of a SLP before swallow is initiated during a MBS observation.
Penetration-Aspiration scale
Examine anatomy for abnormalities & deviations
- View all anatomy including cervical vertebra, UES
- Watch for movement disorders e.g., spasms, tremors
What three basic movement patterns are examined during a MBS?
Phonation
Falsetto
Trumpet maneuever
What three aspects are considered during a bolus movement of a swallow in a MBS?
Does the bolus hesitate? Where? How long? (OTT)
Where is bolus head during ph. reflex trigger? (PTT)
Does bolus enter the airway? When?
Identify the five neuromuscular events taking place during a MBS.
Lip seal, oral tongue movement
Velopharyngeal closure
Hyoid/laryngeal elevation
BOT movement & airway closure
Cricopharyngeal opening
What is discussed immediately after the swallow in a MBS?
Is there post swallow residue? Where?
If aspiration, identify cause. Ask why?
Consequences of impaired swallow
Trial compensatory maneuvers
What area is reviewed if post=swallow residue is discovered during a MBS?
Oral—review oral tongue movement
Valleculae—review BOT movement
Pyriform sinus—review laryngeal elevation & PES opening
Pharyngeal wall—review pharyngeal wall movement
Identify three consequences of an impaired swallow.
Spillage
Residue
Misdirection
What areas are reviewed in swallowing report by a SLP?
Indicate problems, symptoms, causes by stage
Describe the effects of therapy strategies
Recommendations
- Oral or NPO
- Feeding strategies
- Therapy procedures and goals
An Esophagram is AKA (?).
This test provides images from the (?) to (?).
T/F - This test is DIFFERENT from a MBS.
What does the patient swallow during this test?
It provides a visual of (?) & (??).
Pharyngeoesophagram
Oropharynx to LES
False - Same as “traditional barium swallow”
Patient swallows large cup of barium
Visual of motility or structural disorders
What type of study is the same as an esophagram?
What is the difference of this type of study?
What does this type of study reveal?
Upper GI study
UGS includes stomach & Juojenum
Reveals ulcers, tumors, hernias, scarring, blockage, muscle abnormalities
What is another name for a “Milk Scan”?
What does this type of test produce?
Describe the process to use this test.
What does it measure? Quantify?
radionuclide imaging
- Radioactive material mixed in a liquid given
- Observe passage from mouth to stomach
- Measures gastric emptying, may detect GERD
- Quantifies aspiration
Describe the dynamics of a MRI/CT scan.
Great detail and images of structures
Identifies problems in anatomy
Not real time
