Videofluoroscopic Swallowing Study (VFSS)

A videofluoroscopic swallowing study (VFSS) is a test that shows healthcare providers what happens when you swallow food or liquid. It’s a type of fluoroscopy. Healthcare providers may use the term modified barium swallow test. A VFSS creates images as food and liquid move from your mouth, down your throat and into your esophagus.

You may have this test if it’s hard for you to swallow certain liquids, foods or pills. Your provider may recommend it if they think food or liquid gets into your windpipe when you swallow. Content in your windpipe may end up in your lungs and cause an infection. Your child’s pediatrician may recommend this test if your child refuses to eat food or has chest infections.

How does the test work?

In a VFSS, you swallow food or liquid that contains barium sulfate. Your speech-language pathologist or radiologist may call it a contrast agent. These are the healthcare providers who will do your test. Barium in what you consume for the test shows up as black images on the X-ray video. Your providers track the images as they move from your mouth to your esophagus.

How do I prepare for a videofluoroscopic swallowing study?

Your SLP will explain the test process and what you can expect. Now’s a good time to ask questions like:

• Why do you recommend this test for me or my child?
• How long will the test take?
• What does the test liquid or food taste like?
• What happens if I can’t swallow something during the test?

You should tell them what medications you take. They may ask if you’re allergic to certain contrast agents. The test involves X-rays, so it’s very important that you tell them if you’re pregnant or could be pregnant.

They may tell you not to eat or drink anything for a certain period of time before your test. They may also ask you to avoid activities like smoking, chewing gum or sucking on hard candies. These activities cause your salivary glands to make more saliva. Lots of saliva flooding your mouth and throat may affect test results.

You’ll need to stand or sit up in a chair, so plan on wearing comfortable (think nonbinding) clothes.

What to expect during the test

You’ll sip different fluids and eat pudding or a cookie during the test. The fluids may be thin, like sipping juice, or thick, like eating a spoonful of honey. Your speech pathologist will walk you through each part of the test:

1. You’ll stand or sit in a chair in front of the X-ray machine. If your child is having the test, they’ll sit on your lap.
2. Your speech pathologist will tell you when to take a sip of fluid, a mouthful of pudding or a bite of cookie.
3. They may tell you to hold the food or liquid in your mouth until they say it’s OK to swallow.
4. They may say you should swallow whenever you’re ready.
5. They may ask you to turn to one side or the other as you swallow.
6. They may ask you to lift or lower your chin when you swallow. Changing swallowing positions may help move food and liquid through your throat.

Risks

A VFSS is a safe test with few risks. That said, there’s a chance the test food or liquid will end up in your windpipe. Your healthcare providers will watch for that. But don’t hesitate to let them know if you think there’s content in your airway.

What to expect after a VFSS

Your speech pathologist and radiologist will discuss your test results. They may show you the video images so you can see what happens when you swallow. The images may show issues like:

• You have trouble turning food into a small ball or mass in your mouth that you can swallow
• You don’t start swallowing right away, so food ends up in your windpipe
• There are issues with your esophagus, like narrowing, so food or liquid builds up there

Your speech pathologist may suggest you do exercises that may make it easier for you to swallow. They may ask about specific foods that are hard to eat. They may recommend ways you can change the texture of those foods so they’re easier to swallow.

When should I call my doctor?

You should contact your speech pathologist if you or your child has new swallowing issues. They may recommend different ways to manage swallowing.

What’s the difference between a videofluoroscopic swallow study and a barium swallow test?

A barium swallow (esophagram) focuses on your esophagus. A VFSS checks your mouth and throat, along with a limited screening of your esophagus.