A. Rasley et al., PREVENTION OF BARIUM ASPIRATION DURING VIDEOFLUOROSCOPIC SWALLOWING STUDIES - VALUE OF CHANGE IN POSTURE, American journal of roentgenology, 160(5), 1993, pp. 1005-1009
OBJECTIVE. We investigated the frequency with which changes in the pos
ition of a patient's head or body eliminated aspiration of liquid bari
um during videofluoroscopic swallowing studies in patients with oropha
ryngeal dysphagia. We also studied factors that influenced the effect
of posture on aspiration. SUBJECTS AND METHODS. The study group compri
sed 165 patients consecutively referred for videofluoroscopic examinat
ion of the oropharyngeal stages of swallowing in whom aspiration of ba
rium occurred while swallowing 1, 3, 5, or 10 ml of thin liquid barium
or drinking barium from a cup. When aspiration occurred, the patient
changed to one of five postures (chin down, chin up, head rotated, hea
d tilted, and lying down), selected on the basis of the specific swall
owing abnormality causing the aspiration. RESULTS. Changes in head or
body position eliminated aspiration of at least one bolus of barium in
127 (77%) of the 165 patients, and of all four boluses plus drinking
barium from a cup in 41 patients (25%). Postural changes were less ben
eficial in preventing aspiration in patients with substantial language
or cognitive defects or restricted head movement. CONCLUSIONS. Postur
al techniques can eliminate aspiration of barium of at least small vol
umes in most patients. Expansion of the oropharyngeal swallowing study
to include the effect of various postures can be done with minimal ri
sk of increased aspiration.