Modified Mondays: Just a liiiiitle lower, please
This may be shocking, but in the first acute care hospital I every worked in, I did NOT have a good, collaborative relationship with the Radiologists. Radiologists are often impatient with MBS studies-and for a (somewhat) understandable reason. By and large, they make significantly less for an MBS study compared to other procedures, and it takes up a fair amount of their time. They are also not directing the study, and we all know how most physicians feel about that.
Anyhoo… I really struggled with getting the Rads to let me complete an esophageal scan, even when it was clearly indicated. Lots of friendly and less than friendly discussions were involved, and I may have engaged in some passive-aggressive pacing outside their office door when they didn’t want to listen to my justifications and evidence. Now that I work the #mobileMBSlife, I have the ability to scan when necessary, since the SLP completely directs the study…and this video clip is an excellent example of why it’s a good idea.
Patient was complaining of food stuck (kept pointing to sternum), with coughing about 10-15 minutes after meals, especially when she would lay down to rest after eating. She also wasn’t eating very much, and had lost some weight. Orally looked fine, and airway protection was basically delightful. This clip shows what we saw when we turned her and scanned. You will see the large hiatal hernia (when part of the stomach slides through the diaphragm and into the chest cavity), then the rest of the stomach over to the right of the screen and we continue to scan down.
Hiatal hernias are not uncommon, and can occur in 40% of Americans over the age of 50. We were able to make an appropriate referral to GI, and this patient did not have to go through unnecessary therapy or diet modifications. Scanning/screening the esophagus is within our scope of practice and can add valuable information to the assessment, help determine the most appropriate plan of care, and… when you find something like this, help justify to those Radiologists why they shouldn’t give us a hard time for that extra few seconds of fluoro time. Check out the links below for more information!
Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing - PubMed (nih.gov)
Inter-rater reliability for speech-language therapists' judgement of oesophageal abnormality during oesophageal visualization - PubMed (nih.gov)
Improving the Diagnostic Capability of the Modified Barium Swallow Study Through Standardization of an Esophageal Sweep Protocol - PubMed (nih.gov)