Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease.

Forty-one patients with neurologic disease (ND) were evaluated by clinical and videofluoroscopic examination of the oral cavity and pharynx to assess location and severity of swallowing dysfunction using various bolus consistencies. Four different materials were given to each patient, and included low- and high-viscosity barium suspensions, barium paste, and paste-coated cookie. Thirty-five patients had abnormalities of both oral and pharyngeal function. Four patients had pharyngeal dysfunction only, and two patients were normal. Mild swallowing difficulties occurred in five patients (12%), moderate dysfunction in 29 patients (71%), and severe dysfunction in five patients (12%). Thirty-two patients had pharyngeal stasis, which was symmetric in 30 patients (94%) and asymmetric in two. Site of stasis was not related to the type of neurologic disease. Fifteen patients aspirated, most of them (13 of 15) with the low-viscosity barium suspension. The predominance of aspiration with the low-viscosity liquid emphasizes the importance of clinical and videofluoroscopic evaluation of swallowing in dysphagic patients with ND for appropriate feeding recommendations. Thus, videofluoroscopy complemented the clinical examination and defined the type and severity of swallowing abnormalities and aspiration, when present.