{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:53:20Z","timestamp":1781877200150,"version":"3.54.5"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Modified barium swallow studies (MBSS) are one of two gold\u2010standard assessments for oropharyngeal swallowing. It is unclear how many patients referred for outpatient MBSS have normal swallowing despite a subjective complaint of dysphagia. This study examined the rate, referral diagnoses, and referral patterns of outpatient MBSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective descriptive case series was conducted of outpatient adult MBSS between January 1, 2019 and December 31, 2019. Normal MBSS were identified and stratified by present\/absent history of neurological disease or head and neck cancer (HNC). Referral sources and diagnoses were tracked.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six hundred fifteen patients were referred for MBSS. 285 (46%) studies were normal; of these, 209 (73% of normal MBSS; 34% of total MBSS) had no history of neurological disease or HNC and were predominately female (female 128, 61%, male 81, 39%). The primary referral diagnoses for MBSS are: Dysphagia, unspecified (48, 23.0%), Dysphagia, other (6, 2.9%), Dysphagia, pharyngeal (8, 3.8%), Dysphagia, esophageal (14, 6.7%), Dysphagia, oropharyngeal (43, 20.6%), Dysphagia, pharyngoesophageal (12, 5.7%), GERD\/LPR (7, 3.3%), Chronic cough (11, 5.3%), Chronic throat clearing (2, 1.0%), Other (including Zenker's diverticulum 58, 27.8%). The primary referral sources were: ENT (72, 34.4%), Gastroenterology (57, 27.3%), PCP: (23, 11.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nearly half of all patients referred for MBSS were judged to have normal oropharyngeal swallowing. There may be a discrepancy between patient complaint and evaluation results necessitating revision of referral patterns and evaluation methods and consideration of transient or poorly understood presentations of dysphagia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Levels of Evidence<\/jats:title>\n                    <jats:p>4<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70399","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:00:34Z","timestamp":1775552434000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Clinical Pathway of the Normal Outpatient Modified Barium Swallow: A Case Series"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4884-3512","authenticated-orcid":false,"given":"Michelle E.","family":"Adessa","sequence":"first","affiliation":[{"name":"The Voice Center, Head and Neck Surgery, Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"},{"name":"Otolaryngology\u2010Head &amp; Neck Surgery Cleveland Clinic Lerner College of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6774-1418","authenticated-orcid":false,"given":"Christopher G.","family":"Hyland","sequence":"additional","affiliation":[{"name":"College of Medicine Northeast Ohio Medical University  Rootstown Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil A.","family":"Rana","sequence":"additional","affiliation":[{"name":"School of Medicine Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Mahesh","sequence":"additional","affiliation":[{"name":"School of Medicine Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William S.","family":"Tierney","sequence":"additional","affiliation":[{"name":"The Voice Center, Head and Neck Surgery, Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"},{"name":"Otolaryngology\u2010Head &amp; Neck Surgery Cleveland Clinic Lerner College of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1647-0149","authenticated-orcid":false,"given":"Rachel","family":"Mulheren","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2010Head &amp; Neck Surgery Cleveland Clinic Lerner College of Medicine  Cleveland Ohio USA"},{"name":"Department of Psychological Sciences Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Bryson","sequence":"additional","affiliation":[{"name":"The Voice Center, Head and Neck Surgery, Integrated Surgical Institute Cleveland Clinic  Cleveland Ohio USA"},{"name":"Otolaryngology\u2010Head &amp; Neck Surgery Cleveland Clinic Lerner College of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1044\/2020_AJSLP\u201019\u201000189"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1044\/2021_PERSP-20-00303"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004550010015"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00417897"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-1109-7"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30283"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-008-9185-9"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746\u2010160X\u20103\u201026"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3233\/THC-170892"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556131709600205"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-019-10023-y"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fresc.2021.708102"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000444636"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30177"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/17549507.2018.1461931"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000021473"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1044\/2018_JSLHR-S-17-0212"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00021291"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004550010017"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-009-9258-4"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-013-9459-8"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1044\/jshr.3702.314"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28161"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.intcar.2023.100139"},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","unstructured":"B.Martin\u2010Harris M. 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