Videofluoroscopy and air insufflation (x-ray examination of swallowing and tracheoesophageal voicing)

You have been given an appointment for a videofluoroscopy assessment which is a moving x-ray to look at swallowing and tracheoesophageal voicing following your laryngectomy. This is an assessment co-ordinated by the speech and language therapist and run jointly with a second speech and language therapist, a radiographer and occasionally a radiologist. This information sheet provides you with some information about the procedure.

Why have I been given an appointment for videofluoroscopy?

You have been referred to the speech and language therapy department because you have had some difficulties swallowing and/or voicing following your laryngectomy. The speech and language therapists are trained to assess and treat these problems. The videofluoroscopy assessment enables the speech and language therapist to examine your swallowing and voicing in detail. It also enables us to try different foods/drinks and/or different swallowing and voicing techniques if appropriate to attempt to improve your difficulties.

Before my appointment

Unless you have been advised otherwise, you can eat and drink as normal before your appointment. If you are currently feeding through a tube, you can take your feeds as normal up until your appointment time.

Please remove any earrings or necklaces.

If you are a wheelchair user or have difficulties transferring from one chair to another without assistance, please inform the speech and language therapy department as soon as possible prior to your appointment. This is because special arrangements may need to be made to ensure access to this procedure.

What happens during the videofluoroscopy?

The procedure may be slightly different for each patient depending on which area needs to be assessed. Below is an explanation of what you might expect from your appointment with us but your speech and language therapist will be able to explain which of the following procedures they would like to carry out with you:

Swallowing

This procedure is a non-invasive procedure. You will be seated in the x-ray suite while we adjust the x-ray machine around you. The speech and language therapist will then give you different consistencies to eat and drink which contain a contrast liquid. The contrast liquid is used to make the food and liquid show up on the x-ray. The x-ray will run while you swallow to enable the speech and language therapist to see what happens in your mouth and throat. This is recorded on DVD so that the speech and language therapist can analyse it at a later time.

Voicing

You will be seated in the x-ray suite while we adjust the x-ray machine around you. The speech and language therapist will then give you different consistencies to eat and drink which contain a contrast liquid. The contrast liquid is used to make the food and liquid show up on the x-ray. You will then be asked to voice whilst the x-ray is running to enable the speech and language therapist to see what is happening in your throat. You may then be asked to carry out different techniques/ use different types of equipment to see if they can help to improve your voice.

Air insufflation

The speech and language therapist may need to study your voicing difficulties in more detail. One way of doing this is by seeing if air can vibrate freely in your ‘reconstructed segment’ (the area which needs to vibrate to produce your new voice). In order to test this, the speech and language therapist may pass a small rubber catheter into your nose and down into the back of your throat (please see picture above). This may cause mild discomfort but shouldn’t be painful. The speech and language therapist can spray your nose with anaesthetic before this procedure if you feel you need it. The catheter is connected to a baseplate which we will place around your stoma. Once the catheter is in place, you will be asked to voice by covering over the stoma cassette with your finger and the speech and language therapist will analyse what is happening in your throat.

In some cases, the catheter may be connected to an oxygen cylinder instead of the baseplate and small amounts of oxygen can be sent down the tube into your throat to try and produce voice – the speech and language therapist will again analyse what is happening in your throat when this happens.

Once the assessment is complete, the catheter will be gently removed from your nose.

How long will it take?

The procedure takes 15 to 30 minutes and is carried out in the x-ray suite but the appointment may last up to 45 minutes. This is because the speech and language therapist may ask you some questions in relation to your swallowing and voicing before the procedure and will also provide you with feedback on the outcome of the assessment at the end. Although the clinic generally runs on time, you may experience a small delay. Your patience in these circumstances would be appreciated.

What happens afterwards?

There are no side effects from the procedure so you can return to the ward or go home immediately after the appointment. There is no reason why you cannot drive following the videofluoroscopy. However, please be aware that your bowel movements can be white in colour for a day or so as the x-ray contrast passes through your system.

If appropriate, a follow-up appointment will be made for you to see the speech and language therapist. This is to discuss the results in more detail and to give you further advice and/or exercises to make your swallowing and/or voicing easier.

When will I know the results?

The speech and language therapist will be able to give you some basic information and advice immediately after the procedure. However, detailed results will only be available when a detailed report has been written. The report is written by the speech and language therapist after viewing the images. The report will be sent to the speech and language therapist or consultant who referred you to the clinic, and your GP.

Is the procedure safe?

The procedure is completely safe. Exposure to radiation is minimal but female patients should let staff know if they are/ might be pregnant.

Consent form

You will need to provide verbal consent for this procedure on the day of your appointment, therefore please ensure that you have read the information provided on this leaflet. The speech and language therapist will be happy to go through this information again with you and your family/ carer if needed on the day.

You will also be asked if you would be happy for us to use your video pictures for teaching purposes. Addenbrooke’s Hospital is a teaching hospital and the speech and language therapy department is committed to teaching and training both speech and language therapy students and other disciplines. The video of your assessment may be useful for this purpose.

Questions?

If you have any questions about the procedure, you can either speak to the staff when you attend for your videofluoroscopy appointment, or you can call the speech and language therapist on 01223 216200 (Monday to Friday).