Role of videofluoroscopy in evaluation of neurologic dysphagia

Abstract

For many years, videofluoroscopy was considered the gold standard for studies on swallowing disorders, and only recently has its role been challenged, due primarily to the widespread use of videoendoscopy in the evaluation of dysphagia. Albeit, videofluoroscopy still maintains its key role in this area and, in particular, in studies on dysphagia of neurological origin, on account not only of the possibility, with this procedure, to achieve complete and dynamic evaluation of all phases of deglutition, but also the high sensitivity and specificity in revealing the presence of inhalation. Aim of the present investigation was to analyse the technical procedure of videofluoroscopy and the principal indications in the study of dysphagia of neurological origin, in the attempt to reveal the advantages and disadvantages occurring in this examination, also with respect to other methods adopted in the evaluation of dyphagia. In conclusion, at present, no instrumental examination can be defined as ideal for the study of swallowing, but it can be seen that, with each of these procedures, the information forthcoming is actually complementary, thus achieving the aim to proceed as correctly and rapidly as possible, with the management of patients with dysphagia.

Fig. 1

Lateral view of swallow during VFS, showing penetration of contrast medium above vocal cords.

Fig. 2

Lateral view of swallow during VFS, showing penetration of contrast medium below vocal cords (inhalation).

Fig. 3

Lateral view swallow during VFS, demonstrating pharyngeal residue in pyriform sinuses.

Fig. 4

Antero-posterior view of swallow during VFS, showing asymmetrical residue in left pyriform sinus.