"after the contrast passes through the pharynx, follow it down to the distal oesophagus (if a swallowing chair is not preventing you) to rule out a large distal oesophageal lesion/stricture that may be contributing to the swallowing disorder (you also don't want to force and obstructed patient to swallow a large volume of material)"
"AP and lateral scout radiographs of the neck"
"assuming this is normal, turn the patient into the AP position and repeat"
"return to the pharynx in the AP projection and ask the patient to phonate ("ooooh", "eeeeee", etc.) to evaluate for asymmetric pharyngeal motion"
"Zenker diverticulum"
"Killian-Jamieson diverticulum"
"There are few contraindications. If the patient is grossly aspirating on exam, then the exam can be performed quickly and carefully to gather limited information on why the aspiration is occurring / which structures are involved, but this must always be balanced against the risk of large volume aspiration of barium contrast medium, which can markedly impair respiratory function."
"There are many ways of performing the study and it is often tailored to the individual patient. For instance if a patient is grossly aspirating you may start with thicker density materials to improve the likelihood of a successful swallow and then work toward thinner materials in order to "stress" the capacity of the swallowing mechanism. If the patient's swallow is more normal, you may go in the reverse direction. These studies are often performed with a speech pathologist who can direct much of the exam since he or she follows the patient clinically and may be interested in one part of the swallowing function more than another."
"soft palate - superior pharyngeal constrictor musculature seal (e.g. no nasopharyngeal reflux)"