The Clinical Pathway of the Normal Outpatient Modified Barium Swallow: A Case Series

Objective: Modified barium swallow studies (MBSS) are one of two gold-standard assessments for oropharyngeal swallowing. It is unclear how many patients referred for outpatient MBSS have normal swallowing despite a subjective complaint of dysphagia. This study examined the rate, referral diagnoses, and referral patterns of outpatient MBSS. Methods: A retrospective descriptive case series was conducted of outpatient adult MBSS between January 1, 2019 and December 31, 2019. Normal MBSS were identified and stratified by present/absent history of neurological disease or head and neck cancer (HNC). Referral sources and diagnoses were tracked. Results: Six hundred fifteen patients were referred for MBSS. 285 (46%) studies were normal; of these, 209 (73% of normal MBSS; 34% of total MBSS) had no history of neurological disease or HNC and were predominately female (female 128, 61%, male 81, 39%). The primary referral diagnoses for MBSS are: Dysphagia, unspecified (48, 23.0%), Dysphagia, other (6, 2.9%), Dysphagia, pharyngeal (8, 3.8%), Dysphagia, esophageal (14, 6.7%), Dysphagia, oropharyngeal (43, 20.6%), Dysphagia, pharyngoesophageal (12, 5.7%), GERD/LPR (7, 3.3%), Chronic cough (11, 5.3%), Chronic throat clearing (2, 1.0%), Other (including Zenker's diverticulum 58, 27.8%). The primary referral sources were: ENT (72, 34.4%), Gastroenterology (57, 27.3%), PCP: (23, 11.0%). Conclusion: Nearly half of all patients referred for MBSS were judged to have normal oropharyngeal swallowing. There may be a discrepancy between patient complaint and evaluation results necessitating revision of referral patterns and evaluation methods and consideration of transient or poorly understood presentations of dysphagia. Levels of Evidence: 4.