MBS Report

HISTORY

Patient is an 86 year old man with a hx of chronic heart failure and chronic cough. His lungs
were x-rayed 2 months ago and were determined to be clear. The patient is currently on
antibiotics and a steroid to address possible infection that is causing him to cough. Patient and
his wife state that he has been coughing intermittently for several years. He coughs most
frequently during meals, but does cough outside of meals. He is currently not on any reflux
medications and denies having reflux. His baseline diet is regular.

COGNITION/COMMUNICATION

Patient is oriented to person, place, and time. He is alert and cooperated with the clinician
throughout the exam. He communicated with the clinician, responding to her questions and
commenting on the exam. Expressive and receptive language observed to be WNL; speech is
100% intelligible. Vocal quality is mildly hoarse.

ORAL MOTOR EXAM

Weak tongue strength observed for lateralization and protrusion against resistance. Tongue
range of motion was normal. Patient reported dry mouth and oral cavity was observed to be dry.
Normal lips, soft palate and dentition.

CLINICAL SWALLOW EXAM SUMMARY

Patient presents with mild oral and pharyngeal dysphagia characterized by prolonged
mastication, mild residue remaining following solid trials, and patient reports of residue in
addition to observations of throat clearing following most trials. Patient has since been on a
modified diet of alternating every 1-2 swallows of solid boluses with nectar thick liquids.

CONSISTENCIES EVALUATED

Patient was given a modified barium swallow study. Patient was upright and alert during the
entire study. Trials of 5ml thin, 10ml thin, cup sip thin, 5ml nectar, cup sip nectar, puree,
mechanical soft, solid, and barium tablet were administered. Strategies evaluated included chin
tuck, head turn left, and breath hold with head turn.

ORAL STAGE

Mildly impaired but functional. Slowed/weak tongue motion resulted in residue collection on the
tongue in all trials and in the lateral sulci in liquid trials. Residue collection on oral structures
required subsequent swallows to clear for all volumes and consistencies.
PHARYNGEAL STAGE

Mildly impaired during all trials. Weak tongue base retraction and reduced epiglottic inversion
resulted residue collection in the vallecula, which worsened with viscosity. Incomplete anterior
hyoid excursion and lack of laryngeal closure resulted vallecular residue. Diminished pharyngeal
stripping wave and incomplete/narrowed opening of the PES resulted in reduced pharyngeal
pressure and residue collection in the vallecula, pyriform sinuses, and hypopharynx, which
worsened with increased viscosity. Residue collection on pharyngeal structures worsened with
higher volumes and thicker consistencies, requiring subsequent swallows to reduce residue.
Additional swallows helped diminish, but did not successfully clear pharyngeal residue, which
resulted in aspiration. A chin tuck was evaluated on 10ml and cup sip thin, however the addition
of this strategy was not helpful with either consistency and resulted in aspiration on the cup sip.
A head turn to the left helped to reduce residue on puree, mechanical soft trials. A head turn and
breath hold was used for trial of cup sip with thin liquid, which helped to close the airway and
reduce vallecular residue.

ESOPHAGEAL STAGE

The esophageal stage was not evaluated.

IMPRESSIONS

Patient presents with mild oropharyngeal dysphagia characterized by mild to moderate residue
on oral and pharyngeal structures. The main concern is reducing situations that may increase the
risk of penetration or aspiration due to residue collection. A diet of regular solids with the
introduction of alternating dry swallows and head turn, in addition to taking smaller bites during
meals is recommended. Patient can have thin liquids using a left head turn with a breath hold. To
avoid aspirating on thin liquids when taking pills, patient is advised to take pills with pudding or
yogurt. Based on patient history, CSE, and MBS, patient is a good candidate for swallowing
rehabilitation. Using these strategies and recommendations, along with patient willingness to
comply, prognosis is favorable. These strategies should help to reduce some of the patient’s
coughing during meal times while allowing the patient to maintain a fairly regular diet.