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Pros And Cons Of Modifield Barrium Swallow Vs FEEEST? I

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Posted on Sun, 31 May 2020
Question: Pros and cons of Modifield Barrium Swallow vs FEEEST?

I have been having some weird symptoms, where I feel food sticks to my throat, but no chocking or aspiration or weight loss. Rather I have gained weight, this has been going on for the last 4 months or so and happens daily.

I feel like my throat is closing on me and have a tightness/swollen feeling in my throat. When i drink a liquid it feels like its going over something swollen.

I did see an ENT and he looked into my throat and he told me its alright and nothing to worry. He agreed to give me a referral to MBS after I insisted due to tmy anxiety.

I just want to know which is the better procedure for me and is my problem due to reflux? I do have throat reflux for the last 2-3 years.

I also have some weird pressure behind my nose like in the nasopharyngeal area and it contributes to this. I also have some pressure/stiffness on my cheeks and roof of my mouth.

Can FEEEST look at the oral phase too? Is the radiation from MBS harsh on the body and is it well tolerated?
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Follow up: Dr. Sumit Bhatti (0 minute later)
Pros and cons of Modifield Barrium Swallow vs FEEEST?

I have been having some weird symptoms, where I feel food sticks to my throat, but no chocking or aspiration or weight loss. Rather I have gained weight, this has been going on for the last 4 months or so and happens daily.

I feel like my throat is closing on me and have a tightness/swollen feeling in my throat. When i drink a liquid it feels like its going over something swollen.

I did see an ENT and he looked into my throat and he told me its alright and nothing to worry. He agreed to give me a referral to MBS after I insisted due to tmy anxiety.

I just want to know which is the better procedure for me and is my problem due to reflux? I do have throat reflux for the last 2-3 years.

I also have some weird pressure behind my nose like in the nasopharyngeal area and it contributes to this. I also have some pressure/stiffness on my cheeks and roof of my mouth.

Can FEEEST look at the oral phase too? Is the radiation from MBS harsh on the body and is it well tolerated?
doctor
Answered by Dr. Sumit Bhatti (6 hours later)
Brief Answer:
More likely to be reflux or PND.

Detailed Answer:
Hi,

Thank you for your query.

1. At your age, this will mostly be a reflux related problem and possibly a PND (Post Nasal Drip) related to allergies/sinusitis.

2. FEEEST is a newer examination, but the Barium Swallow study also helps as during FEEST the oral stages are difficult to observe. Radiation is less of an issue with newer equipment.

3. I would like to revisit the video-laryngosocpy if you have images of the throat and nose before proceeding for any other investigation. Oesophageal manometry is also necessary in some cases.

4. Please upload any images, previous medication and any other investigations such as for h.pylori and USG abdomen. Any sinus X-ray or Scan? Is there any history of tobacco and/ or alcohol use?

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Sumit Bhatti (0 minute later)
Brief Answer:
More likely to be reflux or PND.

Detailed Answer:
Hi,

Thank you for your query.

1. At your age, this will mostly be a reflux related problem and possibly a PND (Post Nasal Drip) related to allergies/sinusitis.

2. FEEEST is a newer examination, but the Barium Swallow study also helps as during FEEST the oral stages are difficult to observe. Radiation is less of an issue with newer equipment.

3. I would like to revisit the video-laryngosocpy if you have images of the throat and nose before proceeding for any other investigation. Oesophageal manometry is also necessary in some cases.

4. Please upload any images, previous medication and any other investigations such as for h.pylori and USG abdomen. Any sinus X-ray or Scan? Is there any history of tobacco and/ or alcohol use?

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sumit Bhatti (18 hours later)
I don’t have the copy of any of my endoscopies with me right now. I don’t smoke but very rarely do smoke a hookah.

Do you think I am having real swallowing issue or dysphagia or does it sound like gerd?

I haven’t had a ct scan of sinus in the last 3 years.

So is the radiation in modified barium swallow harmful or it’s pretty well tolerated?
Which would you say is a better tool, MBs or feeest?

Will a normal swallow study rule out any weakness of the throat and swallowing muscles if there are any?

I am asking this as I do have stiffness and pressure on my throat and face and roof of my mouth.

Do you think I should go see a neurologist to see if there’s any neurological condition in here?
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Follow up: Dr. Sumit Bhatti (0 minute later)
I don’t have the copy of any of my endoscopies with me right now. I don’t smoke but very rarely do smoke a hookah.

Do you think I am having real swallowing issue or dysphagia or does it sound like gerd?

I haven’t had a ct scan of sinus in the last 3 years.

So is the radiation in modified barium swallow harmful or it’s pretty well tolerated?
Which would you say is a better tool, MBs or feeest?

Will a normal swallow study rule out any weakness of the throat and swallowing muscles if there are any?

I am asking this as I do have stiffness and pressure on my throat and face and roof of my mouth.

Do you think I should go see a neurologist to see if there’s any neurological condition in here?
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Follow up: Dr. Sumit Bhatti (1 minute later)
Can sinus infection cause facial pressure and stiffness especially on the cheeks and roof of mouth?

I don’t have fever or green phlegm, plus all these started after a viral fever back in January and nothing has been the same. Plus due to the virus thing, I am not able to see a doctor or get the tests done.
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Follow up: Dr. Sumit Bhatti (0 minute later)
Can sinus infection cause facial pressure and stiffness especially on the cheeks and roof of mouth?

I don’t have fever or green phlegm, plus all these started after a viral fever back in January and nothing has been the same. Plus due to the virus thing, I am not able to see a doctor or get the tests done.
doctor
Answered by Dr. Sumit Bhatti (3 hours later)
Brief Answer:
LPR (LaryngoPharyngeal Reflux)

Detailed Answer:
Hi,

Thank you for following up.

1. Your symptoms are more likely to be due to LPR (LaryngoPharyngeal Reflux) rather than GERD. The occasional hookah is fine.

2. Radiation during Barium Swallow Study is well tolerated.

3. Ideally I would do the Barium Swallow Study, though it is a slightly older investigation, only after a trial of medication for 2-3 weeks. FEEEST can be used as a follow up study if there is no improvement.

4. Usually neurological conditions will cause difficulty in swallowing liquids. Local causes will cause difficulty in swallowing solids.

5. Sinusitis is common after viral. infections and with allergies. It does cause the symptoms enumerated by you.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Sumit Bhatti (0 minute later)
Brief Answer:
LPR (LaryngoPharyngeal Reflux)

Detailed Answer:
Hi,

Thank you for following up.

1. Your symptoms are more likely to be due to LPR (LaryngoPharyngeal Reflux) rather than GERD. The occasional hookah is fine.

2. Radiation during Barium Swallow Study is well tolerated.

3. Ideally I would do the Barium Swallow Study, though it is a slightly older investigation, only after a trial of medication for 2-3 weeks. FEEEST can be used as a follow up study if there is no improvement.

4. Usually neurological conditions will cause difficulty in swallowing liquids. Local causes will cause difficulty in swallowing solids.

5. Sinusitis is common after viral. infections and with allergies. It does cause the symptoms enumerated by you.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sumit Bhatti (15 hours later)
" Sinusitis is common after viral. infections and with allergies. It does cause the symptoms enumerated by you."
So, can I have the infection for the last 4 months and without fever. My only symptoms seems to be pressure in face, roof of mouth, tightness in my throat.

I also do not have green colored phlegm.

I feel like my throat is tight and that's why it treats normal saliva as excess saliva, could this be an explanation for my excess mucus sensation?

So, can I rule out neurological issue?

I did go and see an ent and all he found was mild inflammation of lingual tonsils. Not sure what to do next.

I did ask him to give me a swallow study and the ent dr has given me a referral for the same. If the problem persists, what should be my next course of action? Go see another ENT or a rheumatologist or a neurologist?
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Follow up: Dr. Sumit Bhatti (0 minute later)
" Sinusitis is common after viral. infections and with allergies. It does cause the symptoms enumerated by you."
So, can I have the infection for the last 4 months and without fever. My only symptoms seems to be pressure in face, roof of mouth, tightness in my throat.

I also do not have green colored phlegm.

I feel like my throat is tight and that's why it treats normal saliva as excess saliva, could this be an explanation for my excess mucus sensation?

So, can I rule out neurological issue?

I did go and see an ent and all he found was mild inflammation of lingual tonsils. Not sure what to do next.

I did ask him to give me a swallow study and the ent dr has given me a referral for the same. If the problem persists, what should be my next course of action? Go see another ENT or a rheumatologist or a neurologist?
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Follow up: Dr. Sumit Bhatti (2 hours later)
I have attached an image where i feel discomfort/pressure/mild pain. This shows up mostly while speaking.

The throat pressure or throat stiffness/pressure/excess mucus in throat sensation is constant and always present for the last 4 months.

I do get pressure on my jaws/cheeks and side of the ears while eating.

Not sure what could be causing this and what my next course of action should be.
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Follow up: Dr. Sumit Bhatti (0 minute later)
I have attached an image where i feel discomfort/pressure/mild pain. This shows up mostly while speaking.

The throat pressure or throat stiffness/pressure/excess mucus in throat sensation is constant and always present for the last 4 months.

I do get pressure on my jaws/cheeks and side of the ears while eating.

Not sure what could be causing this and what my next course of action should be.
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Follow up: Dr. Sumit Bhatti (52 minutes later)
Also, after a meal sometimes my throat is scratchy and I cough not while eating but after a meal like couple of mins after i finish my meal. No issues while eating.
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Follow up: Dr. Sumit Bhatti (0 minute later)
Also, after a meal sometimes my throat is scratchy and I cough not while eating but after a meal like couple of mins after i finish my meal. No issues while eating.
doctor
Answered by Dr. Sumit Bhatti (10 hours later)
Brief Answer:
These are symptoms of allergy, LPR, PND and stress.

Detailed Answer:
Hi,

Thank you for following up.

1. Yes, This distribution of face, neck and neck discomfort is a very common QOL (Quality of Life) issue.

2. The neurological issue is unlikely.

3. These are symptoms of allergy, LPR, PND and stress.

4. The typical cough after eating and the raw scratchy throat is again due to the above causes.

5. The lingual tonsil hypertrophy requires strict diet control, avoiding food that you may be intolerant to, avoiding anxiety, avoiding allergens, preventing reflux, treating the sinusitis and anti-allergy medications, mucolytic medications sometimes a short course of steroids.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Sumit Bhatti (0 minute later)
Brief Answer:
These are symptoms of allergy, LPR, PND and stress.

Detailed Answer:
Hi,

Thank you for following up.

1. Yes, This distribution of face, neck and neck discomfort is a very common QOL (Quality of Life) issue.

2. The neurological issue is unlikely.

3. These are symptoms of allergy, LPR, PND and stress.

4. The typical cough after eating and the raw scratchy throat is again due to the above causes.

5. The lingual tonsil hypertrophy requires strict diet control, avoiding food that you may be intolerant to, avoiding anxiety, avoiding allergens, preventing reflux, treating the sinusitis and anti-allergy medications, mucolytic medications sometimes a short course of steroids.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sumit Bhatti (7 hours later)
So my main concern in here is that the pressure on my cheeks/ roof of my mouth, sometimes makes me mispronounce my words or like a lisp or even like slur my words sometimes.

That’s why I am concerned and feel that could this be due to some neurological issue or some auto immune disease.
No one has noticed anything wrong with my speech.

Can this be due to TMJ but then I don’t have the clicking/popping sound and pain in my jaw, but I do have pressure in my jaws/cheeks/temple/around ears which are common in TMJ, so I am not sure.
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Follow up: Dr. Sumit Bhatti (0 minute later)
So my main concern in here is that the pressure on my cheeks/ roof of my mouth, sometimes makes me mispronounce my words or like a lisp or even like slur my words sometimes.

That’s why I am concerned and feel that could this be due to some neurological issue or some auto immune disease.
No one has noticed anything wrong with my speech.

Can this be due to TMJ but then I don’t have the clicking/popping sound and pain in my jaw, but I do have pressure in my jaws/cheeks/temple/around ears which are common in TMJ, so I am not sure.
doctor
Answered by Dr. Sumit Bhatti (15 hours later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for following up.

1. These symptoms are usually the result of more than one minor problem appearing together.

2. If no one has noticed any change in your speech, it is a good sign.

3. Autoimmune problems are rare and I normally rule them out much later in the workup if there is no response to routine treatment.

4. Mild TMJ does not have all these symptoms. Multiple minor causes usually make diagnosis difficult. The discomfort is real, but the cause/s are not easily found as there is a lot of cross supply in the nervous system of the head, neck and upper body, leading to referred sensations from one site to the other.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Sumit Bhatti (0 minute later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for following up.

1. These symptoms are usually the result of more than one minor problem appearing together.

2. If no one has noticed any change in your speech, it is a good sign.

3. Autoimmune problems are rare and I normally rule them out much later in the workup if there is no response to routine treatment.

4. Mild TMJ does not have all these symptoms. Multiple minor causes usually make diagnosis difficult. The discomfort is real, but the cause/s are not easily found as there is a lot of cross supply in the nervous system of the head, neck and upper body, leading to referred sensations from one site to the other.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Sumit Bhatti (40 hours later)
Thank you for answering to all my questions. So have couple of more questions before and then I will close this.

1.) So, the excess saliva I am talking about is it water brash?
2.) Is throat related symptoms are mild dysphagia and throat tightness sort of chronic with LPR?
3.) Also, the excess mucus in throat is it common with LPR?
4.) Is it possible to have inflammation/infection of sinus or salivary glands with out fever and other symptoms? I just have excess saliva, Post nasal drip and pressure/stiffness in my mouth and face.
5.) What I am describing with my throat being tight, is that sign of throat being spastic?
6.) Can throat be spastic and if so how is that diagnosed and what are its symptoms?

Thanks a lot, you have been of great help.
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Follow up: Dr. Sumit Bhatti (0 minute later)
Thank you for answering to all my questions. So have couple of more questions before and then I will close this.

1.) So, the excess saliva I am talking about is it water brash?
2.) Is throat related symptoms are mild dysphagia and throat tightness sort of chronic with LPR?
3.) Also, the excess mucus in throat is it common with LPR?
4.) Is it possible to have inflammation/infection of sinus or salivary glands with out fever and other symptoms? I just have excess saliva, Post nasal drip and pressure/stiffness in my mouth and face.
5.) What I am describing with my throat being tight, is that sign of throat being spastic?
6.) Can throat be spastic and if so how is that diagnosed and what are its symptoms?

Thanks a lot, you have been of great help.
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Follow up: Dr. Sumit Bhatti (27 minutes later)
7.) Also, is chronic cough and scratchy throat due to reflux?
8.) It weird with excess saliva, your lips should be wet right, mine is dry and I just have the sensation of extra saliva, I am not drooling or anything, could this be due to a some cyst or tumor in and around my face/mouth?
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Follow up: Dr. Sumit Bhatti (0 minute later)
7.) Also, is chronic cough and scratchy throat due to reflux?
8.) It weird with excess saliva, your lips should be wet right, mine is dry and I just have the sensation of extra saliva, I am not drooling or anything, could this be due to a some cyst or tumor in and around my face/mouth?
doctor
Answered by Dr. Sumit Bhatti (38 hours later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for following up.

1. These symptoms are consistent with LPR and PND.

2. Chronic sinusitis by definition has low grade infection/ alletgy/ inflammation.

3. The excess saliva at times is a common complaint which will decrease with treatment. Waterbrash is bitter.

4. No cyst, tumor or spasticity is likely in your case. The discomfort is real, but it subsides slowly with routine treatment.

Wishing you good health,

Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Sumit Bhatti (0 minute later)
Brief Answer:
Details as discussed below:

Detailed Answer:
Hi,

Thank you for following up.

1. These symptoms are consistent with LPR and PND.

2. Chronic sinusitis by definition has low grade infection/ alletgy/ inflammation.

3. The excess saliva at times is a common complaint which will decrease with treatment. Waterbrash is bitter.

4. No cyst, tumor or spasticity is likely in your case. The discomfort is real, but it subsides slowly with routine treatment.

Wishing you good health,

Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2686 Questions

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Pros And Cons Of Modifield Barrium Swallow Vs FEEEST? I

Pros and cons of Modifield Barrium Swallow vs FEEEST? I have been having some weird symptoms, where I feel food sticks to my throat, but no chocking or aspiration or weight loss. Rather I have gained weight, this has been going on for the last 4 months or so and happens daily. I feel like my throat is closing on me and have a tightness/swollen feeling in my throat. When i drink a liquid it feels like its going over something swollen. I did see an ENT and he looked into my throat and he told me its alright and nothing to worry. He agreed to give me a referral to MBS after I insisted due to tmy anxiety. I just want to know which is the better procedure for me and is my problem due to reflux? I do have throat reflux for the last 2-3 years. I also have some weird pressure behind my nose like in the nasopharyngeal area and it contributes to this. I also have some pressure/stiffness on my cheeks and roof of my mouth. Can FEEEST look at the oral phase too? Is the radiation from MBS harsh on the body and is it well tolerated?