Videofluoroscopic Swallowing Study

The test was performed in a sitting position. The lateral view of swallowing 5 mL of water with small amount of barium was recorded with a C-arm videofluoroscope (ZEN-2060, Genoray Co, Seongnam, Korea). A rehabilitation doctor who did not know the patient’s condition analyzed the videofluoroscopic swallowing study (VFSS) results. Abnormal findings in the VFSS results included vallecular residue, pyriform sinus residue, penetration, and aspiration. Vallecular and pyriform sinus residues were graded as follows: grade 0, no residue; grade 1, less than 10% of the height of the vallecula or pyriform sinus in VFSS imaging; grade 2, from 10% to 50%; and grade 3, above 50%. Grade 0 was defined as no residue. Penetration was defined by residue that reached but did not pass through the glottis. Aspiration was defined as follows: (1) visible residue below the glottis reversed by reflex coughing; (2) small amounts of residue through the main airway, but not detected on chest X-ray; or (3) large amounts of residue through the main airway also detected on chest X-ray.