Modified Barium Swallow Exam (Cookie Swallow)

Video swallow exam is a test that is done by a speech pathologist and a radiologist to evaluate your swallowing.   This exam is commonly done because of swallowing difficulties, choking, coughing, frequent pneumonias, neurological conditions and after strokes.   Your clinical doctor will place an order for this test because he suspects an abnormality of swallowing.

The exam does not require special preparation.  You will be seated on a chair next to a fluoroscopy machine.  The speech pathologist will give you foods of various consistencies that are coated with barium.  First thin consistency liquids will be given followed by thicker foods.  The barium let’s us see the liquid or food on the X-ray and how it passes.  It will also allow us to evaluate your swallowing function

One of the main problems we would like to detect is when liquid or food goes down the wrong way or into the airway instead of down the throat into the esophagus. This is called laryngeal penetration if it stays above the vocal cords and aspiration if it goes below.   Liquids or food getting into the airway will cause coughing in many cases.  Saliva and food can get into the lungs. This can cause pneumonia.

Your swallowing mechanism and which way the food goes will be closely observed during the test using continuous X-ray or fluoroscopy.   The speech pathologist will give you foods of various consistencies and the radiologist will operate the X-ray machine.  Both specialists will closely observe while you swallow.

The test is usually complete under 30 minutes.  It takes less time when your swallowing is normal and more time when it’s abnormal.  Sometimes the speech specialist will repeat swallows or give you maneuvers to prevent foods from going into the airway like chin tuck maneuver.  The test is also often videotaped so that it can be reviewed later.

After the test is done, I will usually review the results with the speech pathologist.  We will both issue a report.  The speech pathologist will often make recommendations about diet.  I will focus my report more on whether there was laryngeal penetration or aspiration.  Sometimes I find incidental findings that are unrelated to swallowing, on the X-ray part of the test.