Patient evaluation: barium swallow with videofluoroscopy at 30 frames per second
Potential problems in the swallowing sequence:
(1) lingual incoordination
(2) disorder of oral transfer
(3) problems with laryngeal elevation
(4) nasopharyngeal reflux
(5) disorder of tracheal penetration
(6) delayed triggering
(7) inconsistent triggering
(8) cricopharyngeal spasm
(9) problems with the gag reflex
(10) vallecular pooling
(11) piriform pooling
Grading for each problem:
(1) none (normal)
(2) mild
(3) moderate
(4) severe
Aspiration can occur even when the gag reflex is normal.
Patients with 1 or more moderate or severe problems should be monitored more closely and instructed in hour to reduce the risk of aspiration while swallowing.
