Prevention of barium aspiration during videofluoroscopic swallowing studies: value of change in posture.
OBJECTIVE
We investigated the frequency with which changes in the position of a patient's head or body eliminated aspiration of liquid barium during videofluoroscopic swallowing studies in patients with oropharyngeal dysphagia. We also studied factors that influenced the effect of posture on aspiration.


METHODS
The study group comprised 165 patients consecutively referred for videofluoroscopic examination of the oropharyngeal stages of swallowing in whom aspiration of barium occurred while swallowing 1, 3, 5, or 10 ml of thin liquid barium or drinking barium from a cup. When aspiration occurred, the patient changed to one of five postures (chin down, chin up, head rotated, head tilted, and lying down), selected on the basis of the specific swallowing abnormality causing the aspiration.


RESULTS
Changes in head or body position eliminated aspiration of at least one bolus of barium in 127 (77%) of the 165 patients, and of all four boluses plus drinking barium from a cup in 41 patients (25%). Postural changes were less beneficial in preventing aspiration in patients with substantial language or cognitive defects or restricted head movement.


CONCLUSIONS
Postural techniques can eliminate aspiration of barium of at least small volumes in most patients. Expansion of the oropharyngeal swallowing study to include the effect of various postures can be done with minimal risk of increased aspiration.
Rasley
A
A
Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208.
Logemann
J A
JA
Kahrilas
P J
PJ
Rademaker
A W
AW
Pauloski
B R
BR
Dodds
W J
WJ
D001466:Barium Sulfate; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000000981:diagnostic imaging*; D005471:Fluoroscopy; D006801:Humans; D008875:Middle Aged; D009960:Oropharynx / Q000000981:diagnostic imaging*; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011187:Posture; D012307:Risk Factors; D014743:Videotape Recording
D001466:Barium Sulfate