What to Expect: Modified Barium Swallow Study (MBSS)
A modified barium swallow study (MBSS) also referred to as a videofluoroscopic swallow study is an instrumental assessment of swallowing function. The x-ray machine will allow visualization of the structures of the mouth and throat as you are eating and drinking. Barium, a white radiopaque paste, is added to food and liquids to allow them to be seen on the x-ray. A speech-language pathologist (SLP) may recommend a MBSS get more information about what may be contributing to any swallowing difficulty you may be experiencing and identify if food or liquid is being aspirated (going into the airway) instead of the esophagus. The primary purpose of the MBSS is to determine what is not working with the swallowing mechanism resulting in swallowing issues and develop an appropriate treatment plan.
Prior to the MBSS, the SLP performing the evaluation will often complete a brief interview to ask about your issues swallowing and an oral mechanism examination. After this, you may be seated in a special chair which will position you in a more upright position. MBSS evaluations are completed in a radiology suite or can also be completed in vans for mobile MBSS. In addition to the SLP, a radiologist or radiology technician will also be present to help run the study.
During the MBSS, you will be presented with liquids of varying viscosity (thickness) and different food depending on your particular needs. Food typically consists of applesauce, fruit cocktail, and a harder cookie such as a graham cracker or a Lorna Doone. Dependent on the particular case, liquids may be regular or thickened to a nectar-like or honey-like consistency, also referred to as mildly or moderately thick. Liquids will be presented by a teaspoon then cup followed by a straw if indicated. The food will be covered in a barium paste and the liquids will be mixed with barium to allow them to be visible on x-ray. From personal experience, barium tastes chalky and artificially sweet. The SLP may also have you try different compensatory strategies or postural adjustments to improve the safety or efficiency of your swallow. These may include holding your breath, tucking your chin, turning your head or leaning to one side, or doing a hard swallow. The efficacy of these strategies can only be identified through instrumental assessment.
After the MBSS, the SLP will go over the results of the study while reviewing the video and will provide recommendations for treatment. Treatment should include exercises specific to the physiologic deficits identified from the study and may include referrals to other medical professionals as indicated, compensatory strategies, and diet recommendations. It is important to remember, the purpose of the MBSS is to identify the anatomical or physiological cause of the swallowing issue and recommend treatments specific to those deficits. If you aspirate during the swallow study, the SLP should be able to tell you when (before, during, or after the swallow) and why you aspirated. If for some reason this information is not provided, do not be afraid to advocate for yourself and ask.
