PD Blog Series 3: How to Tell if Swallowing is a Problem: Screening and Testing for Dysphagia

by Reva Barewal February 24, 2025

Swallowing difficulties, or dysphagia, can significantly impact a person’s health, nutrition, and quality of life. Early detection is crucial, especially for individuals with conditions like Parkinson’s disease or stroke, where dysphagia often goes unnoticed in the early stages. Here’s how screening and diagnostic testing can help identify swallowing problems and guide appropriate care.

Self-Screening Tools for Dysphagia

Several validated self-assessment tools help individuals and caregivers identify potential swallowing issues:

Eating Assessment Tool (EAT-10): A simple 10-question survey that evaluates swallowing difficulties and their impact on daily life.
Swallowing Disturbance Questionnaire (SDQ): A screening tool designed specifically for Parkinson’s disease patients.
PILL-5: A questionnaire that helps identify difficulties swallowing pills, which can be an early sign of dysphagia.
Munich Dysphagia Test-Parkinson’s Disease (MDT-PD): Developed to assess dysphagia risk in Parkinson’s patients, though its reliability in detecting aspiration is debated.

If an individual scores high on these tools, further evaluation by a healthcare provider is recommended.

What Happens During a Clinical Swallow Evaluation?

A Clinical Swallow Evaluation (CSE), often performed by a speech-language pathologist (SLP), provides an initial assessment of swallowing function. This includes:

Reviewing medical history and symptoms.
Examining oral and cranial nerve function.
Observing how the patient manages different food and liquid textures.
Assessing signs of aspiration, such as coughing or throat clearing during eating or drinking.
Performing a modified water test to estimate swallow efficiency (though this is not a validated diagnostic tool).

Based on these findings, the SLP may recommend further instrumental testing.

Imaging Tests for Dysphagia Diagnosis

To fully understand swallowing function and determine appropriate management, specialized imaging tests may be required:

Videofluoroscopic Swallow Study (VFSS) / Modified Barium Swallow Study (MBSS)

VFSS is considered the gold standard for assessing oropharyngeal dysphagia. This test involves:

Swallowing barium-coated food and liquids while X-rays capture real-time images.
Evaluating oral and pharyngeal phases of swallowing, including bolus formation, airway protection, and residue clearance.
Identifying risks of aspiration and testing compensatory strategies to improve swallowing safety.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

FEES is another effective method for assessing dysphagia, particularly in patients who cannot undergo VFSS. This test involves:

Passing a small endoscope through the nose to view the throat during swallowing.
Evaluating secretion management, laryngeal function, and signs of aspiration.
Allowing for repeated assessments without radiation exposure.

Advanced Testing for Swallowing Disorders

High-Resolution Manometry (HRM)

This test measures pressure changes in the throat and esophagus to assess swallowing coordination, particularly in neurological conditions like Parkinson’s disease.

Other Evaluation Techniques

Ultrasonography (US): Used in research to assess tongue movement and swallowing effort.
Surface Electromyography (sEMG): Measures muscle activity during swallowing.
Tongue Strength Testing: Assesses lingual muscle function, which plays a key role in safe swallowing.

Why Early Dysphagia Screening Matters

For individuals recovering from stroke or living with Parkinson’s disease, early dysphagia screening using a swallow test and follow-up imaging can prevent complications like malnutrition, dehydration, and aspiration pneumonia. If you or a loved one is experiencing signs of swallowing difficulty, seek an evaluation from a healthcare provider to ensure timely intervention and improve quality of life.