Terry (& Lotjo),
I can understand why you could feel like the test needed to go into more depth, but, from what I know about the test, is they try the various consistencies, and if nothing shows up, there is no need to keep trying. Keep in mind that they're watching the bolus on the video monitor as you swallow, and are paying attention, not only to what happens after you swallow, but before, and how the bolus is transported in your mouth before and during the swallow.
Also, they take into account things about you that they observe while you are there interacting with them, even though they may not specify it is part of the test per se.
Theoretically, there could be a slp and radiologist out there somewhere that are not thorough enough, but, it is such a specialized procedure, and therefore the medical facilities that do offer it have a LOT of previous experience by virtue of the competence level needed to be employed in that capacity; and the frequency that they do the test, because so few places do.
I think, that we as a population, just assume that if there is something wrong with us, that our doctors will know what it is, but unfortunately oftentimes it is not that simple. Not to discourage you, but it can take months, sometimes even years to get the full answer. Doctors usually start out with tests to rule out the obvious, and uncover anything potentially dangerous that can be treated, and then after that, sometimes its just a matter of monitoring to see if what is causing the problems develops more clearly, or goes away.
If you are having constant post nasal drip, that is going to affect your voice. Think about how people sound when they have had a cold. Even though their nose may no longer be stopped up, so long as there is extra phlegm, you can hear the difference in their voice.
If you don't show any improvement, and at your follow up appointment, your doctor has nothing new to offer, then ask what your next step should be for a specialist. Ask if there is a laryngologist within the geographic range that you are willing to travel to, and who takes your insurance. Like I've said here before, even though an excellent ENT looked at my vocal cords, and he admitted they did not look quite right to him, that they possibly looked too thin. He told me (rather than me asking, actually) that I needed to see a laryngologist. It was he who said I needed a higher level of expertise. It took me a while, several months, to get in to see her, because of a variety of factors. But, she took one look, and knew what she was seeing. So, the degree of specialization can matter.
To put it into perspective for you, people first started commenting about my voice in October (I did not notice it, it was how I sounded to others rather than to myself) it took until the following August for me to see the laryngologist. But, along the way I saw my gp, who sent me to a rheumatologist, who kept seeing me, but sent me to an ENT, who wanted me to see the laryngologist.
As to your question about if the swallow feels different with bulbar weakness; the changes are so gradual, that no, I did not notice. I was not consciously aware that I now always had food residue in my mouth when I swallowed, but did not always have that during my lifetime. We, as humans adapt, we compensate. Maybe I was extra clueless, but no, I did not know. Now, (for example) when I drink, a little bit of whatever it is will eventually trickle out my nose, so yeah, I'm aware. And yes, I frequently cough when I drink, but, from the very first swallow study I had, which was before I noticed anything, they found several areas of weakness, and miscoordination during the test.
My best advice to you is to try not to focus too much on any of your problems, and to not try to steer your doctors into a particular course of action. If you don't trust their judgement or diagnosis, go to another doctor. Go to as many as it takes until you are satisfied. Just don't go with a preconceived notion that you have "X" wrong, caused by a specific type of illness, and that the doctor needs to see that too.
I genuinely hope you get some answers soon, but please be prepared for possibly being in the diagnostic process for a while.
Good luck to you.
