MODIFIED BARIUM SWALLOW - CLINICAL AND RADIOGRAPHIC CORRELATION AND RELATION TO FEEDING RECOMMENDATIONS

Clinical and videofluoroscopic evaluation of swallowing were correlate d to determine their agreement and relationship to feeding recommendat ions. We reviewed a total of 148 patients with swallowing difficulties , of which 93 (45 women, 48 men; mean age 62 years) were evaluated by both clinical and radiographic examinations. A variety of materials we re used for clinical bedside evaluation of oral and pharyngeal functio n. Radiographic examination was done with variable viscosity materials and videotape recording of the oral cavity and pharynx. The severity of oral and pharyngeal abnormalities was graded and findings of the ex aminations were compared. The combined results of both evaluations gen erated an index of swallowing difficulty which was correlated to the t ype of diet used if oral feeding was recommended or to a nonoral route of nutrition. In the assessment of oral and pharyngeal dysfunction, c linical evaluation and radiographic examination correlated closely in 94% of patients; however, the status of pharyngeal function was not de termined in 61 (66%) of the 93 patients by clinical examination alone. The combined swallowing index was calculated in 89 patients and its s everity correlated significantly with the type of feeding recommended; 64 patients were placed on one of three types of diets and 25 had ent eral feedings. In conclusion, combined clinical and radiographic exami nations correlated well, but clinical evaluation alone was limited by failure to evaluate the pharynx in many patients. The swallowing sever ity correlated well with final feeding recommendations.