Videofluoroscopic swallowing study (VFSS) Rangahau tirohanga ā-horomi ki ngā pakeke
A videofluoroscopic swallowing study (VFSS) is used to look at your swallowing. A VFSS is a moving x-ray of your swallowing. It is also called a modified barium swallow (MBS).
When you would have a VFSS
The study is used to investigate swallowing problems and guide how to manage and treat them. It can show:
- how the structures in your mouth and throat (pharynx) move
- how food and fluid move through your mouth, throat and food pipe (oesophagus).
The study can be useful if you have had recent changes in your swallowing, including:
- food or fluid spilling out of your mouth
- difficulty moving food around your mouth
- difficulty starting to swallow
- food or fluid going into your nose during or after swallowing
- a feeling of food or fluid still in your throat after you swallow
- coughing or choking when you eat or drink
- pain when you swallow
- a feeling you have a lump in your throat
- difficulty swallowing pills
- a change in how your voice sounds during or after meals.
These changes can have many possible causes, including:
- a condition present at birth
- a developmental condition as a child
- a sudden event affecting your brain or nerves, such as a stroke
- progressive neurological conditions, such as Parkinson disease
- head and neck cancer treatment.
Having a VFSS
A speech-language therapist will run the study with help from medical imaging and radiology staff.
You will be given small amounts of different types of food and fluid to swallow. These will be mixed with barium so they can be seen on the x-ray. Barium is tasteless and safe to eat and drink but it may feel chalky in your mouth.
The study will be recorded and your swallowing assessed carefully after it has finished. You may be shown some images of your swallowing to help you understand what is happening and what needs to be done to improve your swallowing or make it safer.
- You can sit or stand for the procedure.
- You can stay in your own wheelchair if necessary.
- You can bring a whānau member, carer or support worker with you to the procedure.
- Your support person may be able to stay in the room during the study. They will need to wear a lead apron to protect them from the x-rays and be strong enough to stand up in it the whole time.
A videofluoroscopic swallowing study can take from 15 to 45 minutes. Your exposure to x-ray radiation is usually only for between 1 and 5 minutes.
Before your VFSS
The speech-language therapist will talk to you about your swallowing difficulties and the foods and fluids you find most difficult to swallow. They may ask you to bring some of these foods with you to the appointment. Tell them about:
- any allergies you have
- any dietary or cultural requirements you have for food, fluids or mealtimes.
Apart from that, you do not need to do any special preparation. You can eat and drink as normal, before and after the study. If you are fed by tube, you can continue your tube-feeding as normal.
You can ask any questions you have before your examination.
Tell your healthcare provider if you are pregnant or think you might be. VFSS may not be safe in pregnancy as it will expose you to x-ray radiation. This also applies to your support person if they are staying with you.
After your VFSS
The barium used in the study comes out in your poo. You may notice your poo is more white in colour initially. Drinking plenty of fluids can help to clear it out of your body.
Results of your VFSS
The speech-language therapist may give you some initial information and advice at your appointment or make a later appointment to go through the results with you. They will also write a report.
Copies of the report will be sent to you and your healthcare provider. It will include your swallowing diagnosis as well as some recommendations, such as:
- what you should eat and drink (and the texture of food and fluids)
- swallowing techniques that may help you eat and drink more easily and safely
- exercises to help you improve your swallowing.
Risks of VFSS
This is generally a safe study as very little radiation is used. However, x-rays are not safe if you have certain medical conditions, or if you are pregnant.
If you have a lot of problems swallowing, it is possible for a small amount of the barium and food or fluid to go down the wrong way and enter your lungs instead of your stomach.
If this happens, you will get advice to help clear your lungs or be recommended chest physiotherapy to reduce the risk of a chest infection.
Healthcare services may be provided to you only if you make an informed choice and give informed consent to it. This forms part of your rights (Rights 5, 6 and 7) under the Code of Health and Disability Services Consumer Rights (the Code).
The Code and Your Rights/Ōu Mōtika — Health & Disability Commissioner
The 3 rights that together allow for informed consent are:
- Right 5 — the right to effective communication
- Right 6 — the right to be informed
- Right 7 — the right to choice and consent.
This means you must be told about the service being suggested, including any risks or possible complications. You must have the chance to ask as many questions as you need to understand the information you are given.
You also have the right to have someone with you to help you. But the decision to say 'yes' or 'no' must be yours (unless you are unable to make that decision due to illness or other impairment, or sometimes in an emergency).
You also have the right to be given the information in a language you fully understand. You can ask for an interpreter if you need one.
Alternatives to VFSS
If you cannot have an x-ray a different type of test can be done to check your swallowing. This is called a flexible endoscopic evaluation of swallowing (FEES).
With FEES, a narrow tube with a small camera is inserted through your nose to the top of your throat. This allows the speech-language therapist to see your inside your throat before, during and after swallowing.
Referral information
You will need to be referred for a videofluoroscopic swallowing study by your healthcare provider. You cannot self-refer.
This procedure can be done in the public health system or privately.