The Outpatient Adult Swallowing Service provides diagnostic and treatment services to adults with complaints of difficulty swallowing, from a variety of causes including, head and neck cancer, stroke, Parkinson's disease, respiratory problems among others. Comprehensive diagnostic evaluations involve imaging of the swallowing musculature with Video Swallow Studies (VSS) or Fiberoptic Endoscopic Evaluation of Swallowing. Treatment plans are derived from detailed analysis of the finding and individual treatment sessions are tailored to the patient's disorder in collaboration with the patient and family taking patient preferences into consideration. Treatment modalities include swallowing strengthening exercise, diet modification, surface electromyographic biofeedback, and strategies to increase airway protection and swallowing efficiency using evidence based approaches.
Video Swallow Study (also called Modified Barium Swallow Study)
A speech-language pathologist together with the Radiology staff evaluate swallowing by taking a video X-ray while the patient drinks and/or eats liquids and/or soft foods that contain barium. Barium is a type of contrast that allows us to see the muscles of the throat during swallowing. We use barium liquid, pudding and a cookie as needed. No special preparation is necessary for this swallowing study. Patients do not have to refrain from eating or drinking prior to the test. Patients are positioned upright during the test. Even though the test itself lasts a few minutes patients should plan to spend an hour with us. We conduct a thorough interview with the patient before the study so we can gather other relevant medical information. The video X-rays are analyzed to find out the reason for the swallowing problem and often treatment strategies are prescribed to improve the swallowing. The speech pathologist will discuss the results with the patient after the test and make recommendations for treatment. A report of the findings is also provided to the referring physician.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Speech-language pathologists use FEES to assess individuals with suspected difficulty swallowing where the problem is caused by decreased airway protection during swallowing. In this test, a very thin endoscope is inserted gently into the nostril while the patient eats or drinks various consistencies of food or liquids. This exam also enables the clinician to see how well the food or liquid is cleared from the throat and to determine which therapeutic strategies improve swallowing safety and efficiency. The study is digitally recorded for later analysis.
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Massachusetts General Hospital 55 Fruit Street, Boston MA 02114 / (617) 726-2000 / TDD: 617-724-8800