Evaluation | Benefits | Limitations |
Chest radiograph | Inexpensive and widely available, assesses accumulation of injury over time | Insensitive to early subtle changes of lung injury |
HRCT | Sensitive in detecting lung injury, such as bronchiectasis, tree-in-bud opacities and bronchial thickeningLess radiation than conventional CTAssesses accumulation of injury over time | More radiation exposure than plain radiographExpensive |
VSS | Evaluates all phases of swallowingEvaluates multiple consistenciesFeeding recommendations made at time of study | Information limited if child consumes only small quantitiesDifficult to perform in child who has not been feeding by mouthRadiation exposure proportional to study durationCannot be performed at bedsideLimited evaluation of anatomyEvaluates one moment in timeExpensive |
FEES / with sensory testing | Ability to thoroughly evaluate functional anatomyEvaluates multiple consistenciesCan assess risk of aspiration in nonorally feeding child; airway protective reflexes can be assessedFeeding recommendations made at time of studyVisual feedback for caregiversCan be performed at bedsideNo radiation exposure | Blind to oesophageal phase and actual swallowInvasive and may not represent physiological swallowing conditionsEvaluates one moment in timeNot widely availableExpensive |
BAL | Evaluates anatomy of entire upper and lower airwaysSamples the end-organ of damageSample available for multiple cytological and microbiological testsBecoming more widely available | Uncertainty regarding interpretation of lipid-laden macrophage indexIndex cumbersome to calculateRequires sedation or anaesthesiaInvasiveExpensive |
Oesophageal pH monitoring | Current gold standard for diagnosis of GOREstablished normative data in children | Blind to majority of reflux eventsDifficult to establish causal relationship between GOR and aspirationSomewhat invasiveEvaluates one moment in time |
Oesophageal impedance monitoring | Likely future gold standard for diagnosis of GOR with supra-oesophageal manifestationsAble to detect acid and nonacid reflux eventsDetects proximal reflux eventsAble to evaluate for GOR without stopping medications | Lack of normative data for childrenSomewhat invasiveExpensive and cumbersome to interpretNot widely availableEvaluates one moment in time |
Gastro-oesophageal scintigraphy | Performed under physiological conditionsLow radiation exposure | Poor sensitivityMay not differentiate between aspiration from dysphagia or GOR |
Radionuclide salivagram | Child does not have to be challenged with food bolusLow radiation exposure | Unknown sensitivityUnknown relationship to disease outcomesEvaluates one moment in time |
Dye studies | Can be constructed as screening test or confirmatory testCan evaluate aspiration of secretions or feedsRepeating over time allows for broader evaluation | Uncertainty in interpretation owing to variability of techniqueCan only be performed in children with tracheostomies |