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Diagnosing Swallowing Disorders

We swallow 2,000 to 3,000 times each day. It's a life-sustaining and complex action requiring many muscles coordinated by the brain and brainstem.

If you are having problems swallowing, the experts at the UPMC Swallowing Disorders Center can help.

The Four Stages of Swallowing

  1. Oral preparatory stage — this stage takes place in the mouth. It involves biting and chewing to break down food into smaller pieces that mix with saliva. This stage is where the pleasure of eating is derives.
  2. Oral stage — in this stage, the tongue pushes the food or liquid to the back of the mouth and positions it to pass into the throat (pharynx). After this stage, there should be no food or liquid remaining in the mouth.
  3. Pharyngeal stage — the palate, the soft structure that hangs in the back of the throat, raises to prevent food or liquid from entering the nose. The voice box closes to prevent food from entering the windpipe and a muscle at the low end of the throat relaxes to allow food to enter the esophagus.
  4. Esophageal stage — a series of coordinated muscle contractions pushes the food down the esophagus (food tube) and into the stomach.

Testing for Swallowing Disorders

The functional assessment of swallowing disorders includes one or more tests that allow doctors to view the mouth and throat during the process of swallowing.

Modified barium swallow

This x-ray of swallowing finds problems that occur in the:

  • Mouth
  • Throat (pharynx)
  • Voice box (larynx)
  • Wind pipe (trachea)
  • Esophagus
  • Lungs
  • The base of the tongue (back portion of the tongue located in the throat)

A modified barium swallow provides doctors with data:

  • About tongue motion
  • On coordination and timing of the swallow
  • That will guide your treatment

Fiberoptic endoscopic evaluation of swallowing (FEES)

FEES is a standard test using a flexible fiberoptic endoscope, a small tube with a tiny camera and light on the end of it, to view your throat (pharynx) and voice box (larynx).

You may need this test if you:

  • Complain of a weak voice.
  • Choke after eating or drinking.
  • Feel like food is still in your throat.
  • Have a major change in your voice after swallowing.

During the FEES test, your doctor at the Swallowing Disorders Center will:

  • Coat the inside of your nose with a numbing gel.
  • Insert the endoscope through your nose to a spot slightly above the voice box.
  • Give you foods or liquids tinted with food dye.
  • Watch the food or liquid as it passes from the base of the tongue into the esophagus (swallowing passageway).

FEES allows doctors to clearly observe:

  • If you retain foods or liquids in various areas of your throat.
  • If any of the food substances drip near or into the airway causing you to cough or choke.
  • The speed of the swallow.
  • The amount of food or liquid that you do not swallow on the first try.

Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEEST)

An otolaryngologist and speech-language pathologist perform this study FEEST uses a puff of air to test the protective reflexes of the voice box (larynx).


Manometry measures pressures from muscle force (strength) or bolus flow (food moving through the mouth and throat). Manometry tests the strength of swallowing muscles or detects when swallowing muscles are too tight.


This is a combination of a modified barium swallow and manometry.

Transnasal esophagoscopy (TNE)

Doctors use a long thin fiberoptic endoscope with a camera on it to see the inside of the esophagus. During TNE, doctors watch a video monitor to look for any problems with the esophagus.