Tests that further evaluate the upper portion of the swallow are the Modified Barium Swallow (involves eating and drinking foods and liquid with barium in it and then the swallowing process is visible on an X-ray) and the Fiberoptic Endoscopic Evaluation of Swallowing also called a FEES (a lighted scope is inserted through the nose, and then the swallowing of foods and liquids is viewed on a monitor).
Modified Barium Swallow (MBS) is known as the “gold standard” because of its visualization capabilities - Asha
The Modified Barium Swallow (MBS) is known as the “gold standard” because visualization is better for:
Mastication
Tongue propulsion at the onset of the swallow
Arytenoid contact to epiglottis during the swallow
Completeness of epiglottic retro flexion during the swallow
Hyoid and laryngeal elevation
UES opening
Airway closure at the level of arytenoids to epiglottal contact
Aspiration during height of swallow
Esophageal clearance during the esophageal sweep
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) can be also be performed to assess:
Fatigue with meals
Coordination of respiration
Decreased secretion management
Compensatory strategy biofeedback
However, there are some contraindications of FEES:
Severe agitation, inability to cooperate with the examination
Cardiac disorder
History of vasovagal episodes or fainting
Severe movement disorders (dyskinesia)
Severe bleeding disorders and/or recent epistaxis (nosebleed)
History of recent trauma to the nasal cavity or surrounding structures