In the immortal words of Ferris: “Life moves pretty fast. If you don't stop and look around once in a while, you could miss it.” With apologies to Bueller (Bueller? Bueller?) this applies to pretty much every swallow I have ever seen. After years and years of watching MBS studies, it’s sometimes a temptation to skip the review-what could I possibly have missed? The truth is-a LOT. We know that swallowing is complicated, sometimes messy, sometimes quick. It involves a lot of structures, muscles and cranial nerves. Things are happening all the time, from the moment the bolus enters the mouth until it clears past the lower esophagus and enters the stomach.
This clip is a great example. This is a relatively young patient with a recent stroke. During the swallow, keep a close eye on the upper pharynx and you will see the barium pop up and through the VP and into the nasal cavity. It happens quickly, and there are several other things happening at the same time that could draw your eye (including a heavily calcified thyroid cartilage, in case you miss it). One of the many reasons that I love the MBSImp (no financial interest I just genuinely am a huge fan girl) is that it facilitates the assessing SLP’s attention to multiple levels of the swallow every single time. Our CLE area SLP caught the VP insufficiency and made the ENT referral.
(Please note that for this clip, I picked probably the most severe example we have seen in a while-it’s not always this obvious 😊.)
Reviewing the study, every single time, no matter what, is critical for an accurate assessment. In fact, to properly bill, recording the study is required by CMS. Using a tool like the MBSImp is also a great way to make sure that the review is completed in an organized way, which can help us to spot abnormalities and make the needed referrals.
P.S. If you don’t get my joke references at the beginning, please watch “Ferris Bueller’s Day Off” ASAP