Swallowing Diagnostics – An International Comparison
The diagnosis of dysphagia and its underlying cause is essential in order to administer effective therapy. Some of the commonly used modalities for Instrumental Swallowing Assessment include Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Modified Barium Swallow Study (MBSS), while the less common ones are ultrasonography, CT scan, and MRI scan.
Among these methods, studies support the superiority of Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Portable, high-quality equipment is important in order to ensure the procedure is carried out smoothly. Ergonomically designed FEES equipment is available at PatCom Medical. Swallowing Diagnostics in Different Countries:
United States of America (USA)
In addition to non-instrumental swallowing assessment, Speech-Language Pathologists (SLPs) use instrumental techniques for dysphagia assessment in the USA, FEES, and MBSS being at the top. These are either performed independently by the SLPs (FEES) or in conjunction with other professionals such as radiologists, radiology technicians, physiatrists, etc. (MBSS in particular).
In Australia, Clinical Swallow Examination (CSE) and Modified Barium Swallow Study (MBSS) are most commonly used by SLPs. In addition, FEES, muscle testing, CT scan, and MRI scan are also used by SLPs and doctors.
In Canada, MBSS and FEES are frequently used for swallowing diagnostics by SLPs. However, while performing the MBSS presence of a radiologist in addition to an SLP is necessary to establish a diagnosis. Likewise, for FEES, a physician should be present. Other methods of instrumental assessment include ultrasonography, radionuclide scintigraphy, intraluminal pharyngeal manometry, intramuscular electromyography, electromagnetic articulography, esophageal manometry, and the use of electrical or transcranial magnetic stimulation to elicit swallowing evoked potentials. These, however, are beyond the scope of practice of an SLP and are usually performed in teaching hospitals and research facilities.
After an initial assessment, the physician can refer the patient to an SLP, a gastroenterologist, or a neurologist. In NHS, a swallow test is usually carried out by an SLP. MBSS and FEES are among the most commonly used techniques. Other specific tests include diagnostic gastroscopy and manometry and 24-hour pH study.
Following the clinical evaluation, the patient is referred for instrumental assessment. Together with MBSS, FEES is the most commonly chosen method considering its numerous merits, such as feasibility and portability, allowing it to be performed at the bedside. Additional diagnostic modality includes manometry, ultrasonography, and structural and functional assessment of muscles involved in swallowing. Indication depends upon the individual case; the tests can be performed by either a doctor or an SLP.
Dysphagia diagnosis and rehabilitation involves many professionals, nurses, and dental associates being on the top. Videofluorography and videoendoscopy are common instrumental assessments, usually performed by dentists.
In China, clinical assessment combined with MBSS is the most commonly used modality. A doctor may refer the patient to an SLP for diagnostics tests to be carried out.
United Arab Emirates (UAE)
In the UAE, a number of different modalities such as MBSS, FEES, dynamic swallow study, orsophagoscopy, manometry, and imagining techniques like CT scan and MRI scan are being used. These are performed by doctors or SLPs.