Dysphagia: What Happens During a Bedside Swallow Exam
What is a bedside swallow exam for dysphagia?
A bedside swallow exam is a test to see if you might have dysphagia, which causes trouble swallowing. Dysphagia sometimes leads to serious problems.
When you swallow, food passes through your mouth and into a part of your throat called the pharynx. From there, it travels through a long tube called the esophagus. It then enters your stomach. This movement is made possible by a series of actions by your muscles in these areas. If you have dysphagia, the muscles don’t work properly, and you may not be able to swallow normally.
When you breathe, air enters your mouth and pharynx. From there, it travels to your lungs. Normally, a flap called the epiglottis blocks food particles and liquid from going into your lungs. If something does enter your lungs, it’s called aspiration. You are much more likely to aspirate if you have dysphagia. Aspiration is a serious problem. It can lead to pneumonia and other complications.
During a bedside swallow exam, your health care provider assesses your risk for dysphagia and aspiration. The test can be performed in a hospital room and doesn’t need any special equipment. You will first be asked about your symptoms. You will also have a physical exam of the muscles used to swallow. You will then be tested on your ability to swallow different substances.
Why might I need a bedside swallow exam for dysphagia?
If you have dysphagia, aspiration is always a risk. So, dysphagia needs to be identified quickly. Various health problems can lead to it. Some examples are:
- Major dental problems
- Conditions that decrease saliva (such as Sjogren's syndrome)
- Mouth sores
- Parkinson's disease or other neurologic conditions
- Muscular dystrophies
- Blockage in the esophagus (such as from cancer)
You may need a bedside swallow exam if you are having any of the following symptoms:
- Food sticking in your throat
- Difficulty or pain while swallowing
- Certain breathing problems
You may also need this exam if you have a medical condition that puts you at high risk for dysphagia, such as a stroke. You may need the test even if you don’t have any symptoms of dysphagia — you might still be at risk for aspiration.
What are the risks regarding a bedside swallow exam for dysphagia?
A bedside swallow exam is safe. There is a slight risk that you will aspirate during it. This might lead to problems. But your speech-language pathologist (SLP) will try to prevent that.
The SLP typically begins the exam with the substances that are the easiest to swallow. He or she might stop at that part of the exam if you show signs of dysphagia and aspiration. If you have a very high risk of aspiration from dysphagia, you might not be able to swallow anything during your exam.
Ask your health care provider if the exam presents any other risks for you. Follow-up tests may have risks, too.
How do I prepare for a bedside swallow exam for dysphagia?
You don’t need to do much to prepare. You might be told to not eat or drink anything beforehand. You may also want to make a list of your swallowing problems ahead of time so you can share them with your SLP.
What happens during a bedside swallow exam for dysphagia?
The test is most often performed by an SLP, who checks for signs of dysphagia and aspiration throughout the exam.
First, your SLP may ask you questions about the following:
- The nature of your swallowing problems, such as food sticking in your throat or pain while swallowing
- The substances that usually cause these problems
- Frequency, severity, and onset of these symptoms
- Other symptoms that might be related to dysphagia, like heartburn or coughing when eating
- Your medical history
If possible, the SLP may also talk with your family members on what foods you tend to avoid.
During the exam, the SLP will carefully evaluate your teeth, lips, jaws, tongue, cheeks and soft palate. You may need to perform movements like smacking your lips together or sticking out your jaw, and you might be asked to make sounds such as coughing or clearing your throat. The SLP may check your reflexes for gagging and coughing.
You will likely swallow a series of substances. They may range from water to thicker liquids, pureed foods, soft foods and even regular foods. The SLP will note if you have problems chewing, swallowing or breathing. He or she will also check if your voice sounds “wet,” which can be a sign of aspiration.
What happens after a bedside swallow exam for dysphagia?
Many people need to stay in the hospital after this exam - they usually need treatment for other medical problems. If you have the exam while visiting your health care provider, you will likely be able to go home immediately after it. You will usually be told the results right away. If you don’t have any problems with swallowing, you may be able to eat normally again.
You might need follow-up tests if your medical team is still worried that you may have dysphagia. These tests can help identify dysphagia even if you don’t have any symptoms. Sometimes, they can also help pinpoint the source of a swallowing problem. These tests can include:
- Modified barium swallow test (MBS) to visually show if material is traveling into your lungs
- Fiberoptic endoscopic evaluation of swallowing (FEES) as an alternative to the MBS
- Pharyngeal manometry to check the pressure inside your esophagus
You may need treatment if the bedside swallow exam or other tests show that you have dysphagia. In some cases, your medical team can address what is causing your dysphagia. Surgery is one possible treatment.
Whatever the cause of your dysphagia, you will need to take precautions to prevent aspiration. You may need to modify your diet by, for instance, drinking only liquids of a certain consistency, or drinking no liquids at all. You may also need to modify your position while eating, and you may learn special mouth exercises and techniques to help you swallow. If your swallowing is very poor, a feeding tube might be needed for a short period of time.
How long it takes to recover from dysphagia depends on its severity and cause. It’s important for you to work closely with your health care team to obtain the best treatment. If you are moving to another facility or going home, follow your health care provider’s guidelines closely. They can help reduce your chance of aspiration and other medical problems. Only make changes to your diet after talking with your health care provider.
Steps to Take Before the ExamBefore you agree to the test or procedure, make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
The Johns Hopkins Swallowing Center offers specialized swallowing evaluation, diagnosis and treatment for patients with swallowing disorders. Our multi-specialty team includes laryngologists, speech-language pathologists and other specialists, who work together to provide you with personalized and compassionate care.