PREVENTION OF BARIUM ASPIRATION DURING VIDEOFLUOROSCOPIC SWALLOWING STUDIES - VALUE OF CHANGE IN POSTURE

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.