return to: Swallowing Disorders Management Protocols; Clinical Bedside Swallowing Assessment; Management of Swallowing Disorders; Speech Pathologists

VELOPHARYNGEAL CLOSURE

1. At the juncture of the velum and nasopharynx, view sphincteric closure as the patient swallows and phonates oral and nasal sounds and sentences.

APPEARANCE OF HYPOPHARYNX AT REST

1. Scan entire hypopharynx to note surface anatomy appearance and symmetry.

SWALLOWING SECRETIONS/SALIVA

1. Place two drops of food coloring on the tongue and instruct the patient to swallow. As this mixes with saliva and moves into the hypopharynx, observe saliva flow, pooling, and so forth in lateral channels and laryngeal vestibule.
2. If secretions are seen at the level of the glottis, hold green food coloring until after ice chips are given.

RESPIRATION (ABDUCTION)

1. Observe laryngeal structure for rest breathing
2. Sniff (note abduction)

AIRWAY PROTECTION (ADDUCTION)

1. Cough
2. Hold breath (at the level of the throat)
3. Hold breath very tightly
4. Hold breath to the count of seven

PHONATION (ABDUCTION/ADDUCTION)

1. Hold "oo" or "ee"
2. Repeat "ha-ha-ha" "hee-hee-hee" (five to seven times)
3. Count from one to 10.
4. Say "ee" with a very high pitch; model if needed
5. Say "ee" in a high very loud voice; model if necessary

SWALLOWING FOOD AND LIQUID

1. All foods and liquids are colored green with food coloring
2. Guidelines for standard examination
   1. Increase amount with each presentation unless aspiration occurs.
   2. Discontinue if any consistency level or amount of aspiration occurs twice on the same consistency or level.
   3. Order of consistencies will vary, depending on patient needs.
   4. Try therapeutic maneuvers at appropriate points in the exam: head turn, chin tuck, effortful swallow, hold breath-swallow sequence, supraglottic swallow, Mendelsohn maneuver, dry swallows.
      1. Ice chips: Begin with this consistency if patient is NPO at present and appears to be at high risk for aspiration.
      2. Pureed food: Swallow applesauce; administer via syringe/spoon: 5 cc, 10 cc, 15 cc.
      3. Soft solid food: Chew and swallow cheese sandwich; allow patient to take a bite-sized portion. Repeat for two "bites."
      4. Thin liquids: Swallow mild; administer via syringe/straw as follows: 5 cc, 10 cc, 15 cc, 20 cc; 5 consecutive sips with straw.
      5. Thick liquids (optional task if aspiration of thin liquids occurs): Swallow milkshake; administer via syringe/straw: 5 cc, 10 cc, 15 cc, 20 cc; 5 consecutive sips with straw.

SENSATION

1. Performed if the patient shows no sensitivity to the presence of the scope and/or penetration/aspiration of food, liquid, or secretions.
2. Procedure: Light touch of endoscope to:
   1. Midpharyngeal wall
   2. Midbase of tongue
   3. Midepiglottis
   4. Ventricular folds
   5. True vocal folds

REFERENCES

Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216-219.

Langmore SE, Schatz K, Olsen N. Endoscopic and videofluoroscopic evaluation of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991:100.