Fiberoptic Endoscopic Examination Of Swallowing Research Articles

A Tool for the Assessment of Swallowing Safety and Efficiency in Adults: Turkish Adaptation of Boston Residue and Clearance Scale.

The objective of this study was to create a Turkish language adaptation of the Boston Residue and Clearance Scale (BRACS), a validated and reliable tool. The BRACS scale was first translated into Turkish and a Turkish version was subsequently developed. Fiberoptic endoscopic examination of swallowing (FEES) was administered to collect data from 25 dysphagic patients who were hospitalized after a stroke. The recorded films were subjected to editing procedures to ensure their appropriateness for the assessment of swallowing disorders and were then dispatched to a panel of five speech and language therapists for evaluation using the adaptation of the BRACS instrument. The scoring by the experts was evaluated using both explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity, item reliability, and construct (composite) reliability were measured by calculating the average variance extracted (AVE) values. For the 12 location items, EFA revealed 3 main latent factors: the laryngeal vestibule and the oropharynx and hypopharynx. The Turkish BRACS had excellent inter-rater reliability (Krippendorff's alpha coefficient values ranged from 0.93 to 0.95) and high internal consistency (Cronbach's alpha values ranged from 0.88 to 0.93). Inter-rater ICCs for the first and second sessions were 0.83 and 0.85, respectively. CFA showed that all fitted criteria reached acceptable or perfect fit levels. The findings indicated that the proposed factor structure was validated. The AVE values are between 0.61 and 0.73 which was taken as evidence of convergent validity. The Turkish adaptation of the BRACS tool demonstrates both reliablity and validity, rendering it a useful and credible tool for assessing residual severity, particularly in clinical settings.

Analysis of swallowing and voice-related quality of life in patients after supracricoid partial laryngectomy

ObjectiveThis study evaluated the swallowing and voice function of laryngeal cancer patients after Supracricoid Partial Laryngectomy(SCPL), and its influence on quality of life to provide a reference for the selection of surgical methods for laryngeal cancer patients.MethodsTwenty-one patients who received SCPL between April 2015 and November 2021 were included. Each patient’s swallowing function and quality of life were assessed through fiberoptic endoscopic examination of swallowing (FEES) and the M.D. Anderson Dysphagia Inventory (MDADI). Fundamental, jitter, shimmer, maximum phonation time (MPT), and voice handicap index-10 (VHI-10) were performed to assess voice function and voice-related quality of life.ResultsThe results of the FEES of the 21 patients were as follows: the rates of pharyngeal residue after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 38.09%, respectively; the rates of laryngeal infiltration after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 4.76%, respectively; and aspiration did not occur in any of the patients. In the evaluation of swallowing quality of life, the mean total MDADI score was 92.6 ± 6.32. The voice function evaluation showed that the mean F0, jitter, shimmer, and MPT values were 156.01 ± 120.87 (HZ), 11.57 ± 6.21 (%), 35.37 ± 14.16 (%) and 7.85 ± 6.08 (s), respectively. The mean total VHI-10 score was 7.14 ± 4.84.ConclusionSCPL provides patients with satisfactory swallowing and voice function. The patients in this study were satisfied with their quality of life in terms of swallowing and voice. SCPL can be used as a surgical method to preserve laryngeal function in patients with laryngeal cancer.

Assessment of diabetes as a risk factor for neurogenic dysphagia confirmed by FEES examination in post-CVA patients

IntroductionDiabetes mellitus (DM) is an independent factor for the occurrence of neurogenic dysphagia following an acute cerebrovascular accident in the form of a stroke. This study assesses the role of DM as a risk factor for post-stroke dysphagia (PSD), confirmed by the fiberoptic endoscopic examination of swallowing (FEES) with particular emphasis on silent aspiration (SA) as a high risk factor of aspiration pneumonia (AP).AimThe aim of the study is to assess the role of DM as a risk factor for PSD.Material and methodsStatistical analysis was performed on the cohort of 81 post-cerebrovascular-accident patients hospitalized in the neurological rehabilitation department. DM was diagnosed in more than one third of the cohort (35.8%). After the FEES examination, which was assessed in the penetration–aspiration scale (PAS), an analysis of DM incidence was performed in patients with diagnosed pharyngeal dysphagia of moderate degree (PAS 3–6) and severe degree (PAS 7–8).Results and discussionThe incidence of DM in patients with moderate dysphagia was lower than in the cohort. The incidence of DM in patients with severe dysphagia (aspiration) was comparable to the percentage in the cohort. Although diabetes was twice as frequent among patients with aspiration than among those with mild dysphagia (24% vs. 12%), the odds ratio (OR) of the diabetes incidence in these groups was not statistically significant.ConclusionsAlthough DM is an independent factor for PSD occurrence after cerebrovascular accident in the form of a stroke and a potential factor for lower cranial nerve neuropathy, no correlation between DM and PSD was found.

Lung ultrasound supports clinical evaluation of feeding competence development in preterm neonates.

The achievement of alimentary competencies is a milestone in the development of preterm neonates. Ten percent of neonates <37 weeks of gestational age and 25% of those VLBW experience swallowing disorders, with an increased risk of problems in the early phase of life (failure to thrive, growth retardation, inhalation, and consequent risk of pulmonary infection) and later in life due to delayed development of oromotor skills.The main diagnostic tools for swallowing disorders are endoscopic (fiber-optic endoscopic examination of swallowing, FEES) or radiographic (videofluoroscopic swallowing study, VFSS) exams. Given the invasiveness of these methods and the bias due to rheologic differences between bolus and contrast medium, FEES and VFSS are poorly reproducible. Moreover, neither of the technique is capable of detecting post-meal inhalations, especially microinhalations or those consequent to a whole meal rather than to a single swallowing.Lung ultrasound (LUS) is a widespread, repeatable, safe, fast point-of-care tool and we reported previous encouraging results in detecting silent and overt inhalation related to the meal in children with dysphagia/gastroesophageal reflux disease (GERD) risk factors. We report a pilot study, that investigated LUS approach (performing imaging before and after meals) to assess feeding competence development in a cohort of n. 19 newborns <32 weeks of age. Meal monitoring by LUS did not show any significant difference in scoring before/after eating. The achievement of full enteral feeding correlates with GA at birth (p < 0.001) but not with LUS scoring. The introduction of the first meal by bottle correlates both with gestational age (p < 0.001) and ultrasound scores (p = 0.004). LUS score at 7 days of life resulted predictive for length of invasive/non-invasive respiratory support (p = 0.002) and length of oxygen supply (p = 0.001), while LUS score at 48 h of life did not (p n.s.). Our study suggests that the development of oral feeding skills is not strictly dependent on gestational age. Moreover, our research suggests the predominant role of LUS in predicting the time of readiness to oral feeding, as the LUS score can be a marker of respiratory and lung wellness, and consequently a predictor of neonate stability during deglutitory apnea.

The Complete Lateral Position Method Reduced the Mortality Rate among Elderly Patients with Severe Dysphagia.

Objective This study aimed to validate the efficacy of the complete lateral position method among elderly patients with severe dysphagia. Methods We enrolled 103 patients >65 years old who were diagnosed with severe dysphagia via the fiberoptic endoscopic examination of swallowing and were treated with the complete lateral position method at Hida Municipal Hospital between February 1, 2015, and October 31, 2020. Patients treated with the complete lateral position method were included in the lateral position group, and patients treated with conventional methods were included in the control group. The mortality rates were then compared between the lateral position and control groups. Results All patients had severe dysphagia. However, the complete lateral position method significantly decreased the mortality rate in the lateral position group compared with the control group (64.7% vs. 38.8%; p<0.01). In the lateral position group, approximately 55.6% of patients who were discharged from the hospital were able to safely take food orally again in the sitting position. Furthermore, the complete lateral position method significantly shortened the fasting period and improved the prognosis in patients whose condition had progressed due to senility in the lateral position group compared with the control group (17.3 vs. 8.8 days, p<0.05; 28.4 vs. 67.5 days, p<0.05) Conclusion The complete lateral position method facilitated safe oral ingestion among elderly patients with severe dysphagia. Furthermore, safe oral ingestion decreased the mortality rate and shortened the fasting period at the end of life. The method is easy to implement and does not require the use of special devices or techniques. It can therefore be a useful approach in the care of elderly patients with severe dysphagia.

Cross-Cultural Adaptation and Validation of the European Portuguese Dysphagia Handicap Index.

The Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQoL) 25-item questionnaire assessing the physical, functional, and emotional aspects of patients with oropharyngeal dysphagia (OD), of heterogeneous etiologies. The purpose of this study is to translate and validate the European Portuguese-DHI (EP-DHI). This is a prospective study that was carried out at Centro Hospitalar Universitário do Porto (CHUPorto). The generated EP-DHI was administered to 132 patients with OD and 112 healthy control subjects. 132 patients undergoing fiberoptic endoscopic examination of swallowing (FEES). 15 patients were contacted by phone, 2 or 3weeks later after the first interview to repeat the questionnaire. The validity of concurrent criteria was evaluated by comparing the results of the EP-DHI score with the score attributed to the pathological findings found in FEES and, consequently, Functional Oral Intake Scale (FOIS). The internal consistency of EP-DHI was successful: Cronbach's alpha coefficient for total EP-DHI was 0.874. The test-retest reliability for the total and the three EP-DHI subscales obtained a Pearson's correlation coefficient ranged from 0.990 to 0.712. This study demonstrates that EP-DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on physical, functional, and emotional aspects of patient's quality of life, among an European Portuguese sample.

Observation on the efficacy of post-stroke dysphagia treated with He's santong acupuncture therapy through surface electromyography: a randomized controlled trial

To observe the clinical therapeutic effect on post-stroke dysphagia treated with He's santong (triple promotion) acupuncture therapy through surface electromyography (sEMG). A total of 60 patients with post-stroke dysphagia were divided into a routine treatment group and a He's santong acupuncture therapy group, using blocked randomization, 30 cases in each one. In the routine treatment group, the secondary prevention and swallowing rehabilitation training were adopted. In the He's santong acupuncture therapy group, on the base of the treatment as the routine treatment group, weitong (mild promotion, routine acupuncture at bilateral Fengchi ［GB20］, Fengfu ［GV16］, Yifeng ［TE17］, Lianquan ［CV23］, Jia-lianquan ［Extra］, Fenglong ［ST40］ and Tongli ［HT5］, needle retaining for 30 min, 5 treatments a week), wentong (warm promotion, pricking with fire needle at bilateral GB20 and CV23, twice a week) and qiangtong (strong promotion, blood-letting with three-edge needle at Jinjin ［EX-HN12］, Yuye ［EX-HN13］ and Yanhoubi ［Extra］, twice a week) treatment was added. The therapy was given consecutively for 4 weeks in each group. The score of fiberoptic endoscopic examination of swallowing (FEES) and Rosenbek-penetration-aspiration scale (PAS), the score of swallowing grading scale, the score of the modified Mann assessment of swallowing ability (MMASA) and the peak amplitude of sEMG were recorded before and after treatment in patients. Compared with before treatment, the score of FEES and PAS after treatment was decreased (P<0.05), the scores of swallowing grading scale and MMASA after treatment were increased in both routine treatment group and He's santong acupuncture therapy group (P<0.05), the peak amplitude of sEMG was increased (P<0.05) in the He's santong acupuncture therapy group and decreased (P<0.05) in the routine treatment group. Compared with the routine treatment group, the score of FEES and PAS was decreased (P<0.05), the scores of swallowing grading scale and peak amplitude of sEMG were increased in the He's santong acupuncture therapy group (P<0.05). He's santong acupuncture therapy is obviously effective on post-stroke dysphagia, which may be related to its effects in increasing the contraction of swallowing-related muscles and improving the peak amplitude of hyoid muscle group.

Validation and Cultural Adaptation of an Arabic Version of Pediatric Eating Assessment Tool (Pedi-EAT-10Arabic)

Pediatric eating assessment tool (Pedi-EAT-10Arabic) is a validated and reliable caregiver administered outcome instrument designed for detection of children at high risk of penetration/aspiration. The objective of this study is to translate and validate the Arabic version of Pedi-EAT-10 and to correlate its results with pharyngeal residue and aspiration on fiber optic endoscopic examination of swallowing (FEES). A cross-sectional study including 202 children selected randomly from those attending the swallowing clinic in phoniatrics unit, Otorhinolaryngology department (ORL) at main university hospital between February 2019 and October 2020 complaining of dysphagia. For test–retest reliability, one hundred caregivers refilled the Pedi-EAT-10Arabic after a 2-week period following their first visit. Validity was established by comparing the scores of dysphagia patients to healthy controls. Internal consistency of Pedi-EAT-10Arabic was high (Cronbach's alpha 0.986). Intra class correlation showed excellent test–retest reliability (r = 0.968). The median Pedi-EAT 10Arabic score was significantly higher in dysphagia group compared to healthy controls. (Median 27 IQR 21–34 for cases compared to median zero IQR 0–2 points for healthy controls, P less than 0.001). A strong correlation was found between Pedi-EAT 10Arabic scores and PAS scores with Spearman's correlation coefficient r = 0.803 and P < 0.001. The ROC for evaluating the discriminatory capacity of Pedi-EAT 10 for aspiration showed an AUC of 0.92 (95% CI of 0.89 to 0.96). Conclusion: Pedi-EAT 10Arabic was found to be a valid and reliable screening tool for further instrumental assessment of risk of dysphagia in pediatric population.

Long-term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment.

Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20mL water according to the Penetration and Aspiration Scale (P<.05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20±3.24 in the RT group (P<.05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P>.05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5mL and 10mL water, 5mL and 20mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P<.05). It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.

Fiberoptic Endoscopic Examination of Swallowing (FEES) Evaluation in Post Stroke Patients

Introduction. Complications caused by post-stroke dysphagia increase the morbidity and mortality of patients. Although it has a significant effect on the functional abilities and worsening of the patient's prognosis, post-stroke dysphagia is still under-noticed and often undiagnosed. The importance of knowing the incidence of post-stroke dysphagia, not only to determine its relationship to the pathology of the disease but also to determine treatment plans or follow-up interventions. This study aims to determine the incidence of FEES findings in post-stroke dysphagia both hemorrhagic and non-hemorrhagic stroke.&#x0D; Methods. Forty post-stroke patients in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of Dr. Hospital. Mohammad Hoesin Palembang conducted a FEES examination to see leakage, residue, penetration, and aspiration after being given six different types of food boluses ranging from filter porridge, rice porridge, oatmeal, water, milk, and biscuits. The results of the assessment are recorded and analyzed descriptively.&#x0D; Results. From 40 research subjects found 25 people experiencing dysphagia, where subjects with non-hemorrhagic stroke types were 21 people (52.5%), while hemorrhagic stroke types were four people (10%). The occurrence of leakage of filter porridge was 5 findings, leakage of rice porridge was eight findings, oatmeal leakage, water, and milk were seven findings each, and biscuit leakage was two findings. The incidence of filtered pulp residues was 12 findings, rice porridge residues were 14 findings, oatmeal residues were 15 findings, water and milk residues were five findings each, and biscuit residues were eight findings. The incidence of penetration of filter porridge, rice porridge, and biscuits was one finding each, oatmeal penetration was not found, while water and milk penetration were six events each. The aspirations of filter porridge, rice porridge, oatmeal, and biscuits were not found, while water and milk aspirations were seven findings.&#x0D; Conclusion. The incidence of dysphagia in post-stroke patients both hemorrhagic and non-hemorrhagic in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of the Mohammad Hoesin Hospital Palembang Palembang is quite high at 62.5%. The occurrence of food residues is the most FEES findings. While aspirations are the fewest findings.

Pharyngeal Manometry in Pediatric Dysphagia Assessment

PurposeReliable measures to capture swallowing pathophysiology and outcomes from therapeutic interventions are needed in the pediatric setting. Therefore, this review presents the current best evidence for manometry investigation and its application in pediatric dysphagia. For oropharyngeal dysphagia assessment, videofluoroscopic swallow study is considered the gold standard, and fiberoptic endoscopic examination of swallowing is also employed in some settings. In clinical practice, both tests mostly rely on qualitative interpretation of image data and have variable reliability to detect pathophysiology.ConclusionAcknowledging that swallowing is a pressure-driven event, the role of manometry is now being considered as an objective, nonradiological technique that can be performed as an adjunct to other clinical swallow evaluations. The latest high-resolution manometry catheter technologies are miniaturized and simple to use, enhancing their potential application in pediatric clinical and research contexts.

Assessment and Management of Dysphagia with Fiberoptic Endoscopic Examination of Swallowing (FESS) and its Future Implementation in Indonesia

-

Association Between Laryngeal Sensation, Pre-swallow Secretions and Pharyngeal Residue on Fiberoptic Endoscopic Examination of Swallowing.

Reduced laryngeal sensation and accumulated pharyngeal secretions are known predictors of aspiration. Yet, their association with residue has not been fully explored. One Hundred and ten fiberoptic endoscopic examination of swallowing (FEES) examinations were retrospectively analyzed. Murray's secretion scale (MSS) for secretion stasis and laryngeal sensation were tested for association with residue severity (Yale pharyngeal residue severity rating scale, YPR-SRS) and the number of swallows required to clear the bolus. The bolus challenges of each consistency (liquid, purée and solid) with the highest PAS and YPR-SRS scores were analyzed. Impaired laryngeal sensation (ILS) and MSS were both independently significantly associated with higher YPR-SRS for all consistencies examined. Mean YPR-SRS for patients with both ILS and secretion stasis was respectively 2.4 ± 1.1, 2.5 ± 1.2, 2.4 ± 1.2 for liquid, purée and solids in the vallecula, and 2.9 ± 1.3, 2.3 ± 1.1, 2 ± 1 for pyriform sinuses residue compared to 1.8 ± 0.7, 1.6 ± 1, 1.6 ± 1 for vallecular residue and 1.8 ± 0.8, 1.4 ± 0.8, 1.3 ± 0.7 for pyriform sinus residue of patients with normal laryngeal sensation and no stasis (p < 0.05 for all except liquids in vallecula). The combined findings of both ILS and MSS ≥ 1 had a sensitivity of 25.9%, specificity of 94.2%, positive predictive value (PPV) of 83.3% and negative predictive value (NPV) of 53.3% for prediction of pharyngeal residue and a sensitivity of 58.3%, specificity of 88.8%, PPV of 39.9% and a NPV of 94.6% for prediction of aspiration. Both ILS and MSS were significantly associated with increased number of swallows required to clear a bolus. Abnormal laryngeal sensation and secretion stasis are associated with pharyngeal residue severity and reduced residue clearing on FEES.

Does the Hebrew Eating Assessment Tool-10 Correlate with Pharyngeal Residue, Penetration and Aspiration on Fiberoptic Endoscopic Examination of Swallowing?

The Eating Assessment Tool-10 (EAT-10) is a 10-item patient-reported outcome measure (PROM) for dysphagia patients. The objective of this study was to translate and validate the EAT-10Heb and to test for a correlation between its score and residue, penetration and aspiration on Fiberoptic Endoscopic Examination of Swallowing (FEES). 136 patients visiting two specialized dysphagia clinics and undergoing FEES between April 2015 and August 2017, filled the EAT-10Heb. 23 patients refilled the EAT-10Heb during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency, maximum 3 points) and penetration and aspiration (1 point for penetration, 2 points for aspiration per consistency, maximum 6 points). 51 healthy volunteers also filled the EAT-10Heb. Internal consistency and test-retest reproducibility were examined for reliability testing. Validity was established by comparing EAT-10Heb scores of dysphagia patients to healthy controls. The EAT-10Heb score was then correlated with the FEES score. Internal consistency of the EAT-10Heb was high (Cronbach's alpha = 0.925) as was the test-retest reproducibility (Spearman's correlation coefficient = 0.82, p < 0.0001). The median EAT-10Heb score was significantly higher in the dysphagia group compared to healthy controls (13, IQR 7-22 points for dysphagia patients compared to 0, IQR 0-0 points for healthy controls, p < 0.0001). A weak correlation was found between the EAT-10Heb scores and the FEES score (Pearson's correlation coefficient = 0.376, p < 0.0001). While the EAT-10Heb was found to be a reliable and valid PROM, it only weakly correlates with the pathological findings on FEES examination.

Multidimensional Rehabilitation in Patients with Aspiration Following Head and Neck Cancer Treatment

Patients who have the head and neck cancer are usually treated by surgery, radiation therapy, chemotherapy, or combinations of them. These treatments can induce variable degree of aspiration with dysphagia. The type and severity of aspiration depends on the size and location of the original tumor, the structures involved, and the treatment modality used for treatment. The management of aspiration after the head and neck cancer’s treatment begins with an accurate evaluation for the cause and mechanism of aspiration through modified barium swallow (MBS) and fiberoptic endoscopic examination of swallowing (FEES). Then, the clinician can use postures, maneuvers, and exercises to treat the swallow disorder and to help the patient achieve optimal function. To achieve optimal swallowing without aspiration, multidimensional rehabilitation by various medical personnel is definitely necessary. Key words: Head and neck cancer ㆍ Aspiration ㆍ Dysphagia ㆍ Rehabilitation 핵심용어: 두경부암 ㆍ 흡인 ㆍ 연하곤란 ㆍ 재활

Correlation Between Pharyngeal Residue and Aspiration in Fiber-Optic Endoscopic Evaluation of Swallowing: An Observational Study

ObjectivesTo examine the correlation between pharyngeal residue severity and clearance to penetration/aspiration on fiber-optic endoscopic examination of swallowing (FEES). DesignRetrospective cohort. SettingKaplan Medical Center dysphagia clinic. ParticipantsPatients (N=110) visiting a dysphagia clinic between 2014 and 2016 undergoing FEES. InterventionsFEES were scored for penetration/aspiration with the Penetration Aspiration Scale (PAS), for residue severity using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS). The numbers of swallows required to clear the pharynx were recorded. The first and the worst bolus challenges for each consistency (liquid, purée, solid) were analyzed. Main Outcome MeasuresYPR-SRS and number of clearing swallows were correlated with the PAS of the same bolus challenge. ResultsThe study population’s mean age was 67±13.4 years; 54% were men (n=58). A significant correlation was found between the YPR-SRS and the PAS for all consistencies tested, in each anatomical site (vallecula or pyriform sinus) and for both the first and worst bolus challenges (P<.001 for all). The correlation of residue with aspiration was stronger when vallecula and pyriform sinuses scores were summated (Pearson product-moment correlation coefficient=0.573/0.631/0.446 for liquid/purée/solid for worst bolus challenge). Incorporating the number of clearing swallows to the YPR-SRS strengthened the correlation with PAS. ConclusionsResidue severity and clearance correlate with penetration/aspiration on FEES. The YPR-SRS can be applied to standardize description of residue in FEES and to aid in dysphagia evaluation.

Fiberoendoscopic Evaluation of swallowing - FEES: procesure with an assesment questionare

The endoscopic examination of swallowing FEES (fiberoptic endoscopic examination of swallowing) belongs to the basic instrumental examinations used in diagnostics of oropharyngeal dysphagia. It consists of three parts: I. Evaluation of the anatomy and physiology of the throat and larynx; II. Assessment of drinking and eating liquids and foods with different consistencies; III. Evaluation of the effectiveness of therapeutic maneuvers. The purpose of the work is to present the test procedure and the form used to describe it.

Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients

The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects ofdysphagia patients' quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1-7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach's alpha = 0.96), as was the test-retest reproducibility (Spearman's correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI's total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18-56 for dysphagia patients compared to 0, IQR 0-2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman's correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson's correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients' QoL.

FEES in Infants with Swallowing Disorders - A Feasible Procedure?

Although FEES has been established as a valid procedure in instrumental evaluation of swallowing even in young children, the significance of the endoscopic method on infants has not yet been fully clarified. The aim of this prospective study was to evaluate fiberoptic endoscopic examination of swallowing in infants by focusing on its feasibility and limits. From 11/2011 to 3/2015 27 infants from a neuropediatric hospital presented for fiberoptic endoscopic examination of swallowing. Compared with Langmore standard FEES was carried out in a modified algorithm. In 24 of the 27 infants information about swallowing pathology could be obtained. Silent aspiration of saliva (Penetration Aspiration Scale (PAS) level 8) or silent deep penetration of test diets to the level of the glottis (PAS level 5) presented in 10 children and overt deep penetration of test diets in 3 children. In no case a sufficient insight into the subglottis or trachea could be obtained. Therefore a differentiation of silent deep penetration and aspiration of test diets was impossible. As a consequence of the FEES results, probe and diet management was changed in 7 children. In this study fiberoptic endoscopic evaluation of swallowing in a modified algorithm turned out to be a feasible tool for the diagnostics of swallowing disorders in about 89 percent of the infants. The procedure was limited in terms of providing direct evidence on aspiration in cases of deep penetrations of test diets.

Cranial Nerve Examination for Neurogenic Dysphagia Patients

This cross-sectional study aimed to validate a cranial nerve assessment for swallowing against fiber optic-endoscopic examination of swallowing (FEES) in a group of neurological patients. A specific cranial nerve evaluation was designed, comprising semi-qualitative evaluations of the main five cranial nerves involved in swallowing. Eighty-five participants were consecutively recruited with the following inclusion criteria were: a) neurological diagnosis; b) ability to respond to simple verbal command; c) absence of citrus allergy and age<18 years. All participants first underwent cranial nerve examination (the “I&I” test), followed by a FEES conducted by a blinded otolaryngologist who completed the penetration aspiration scale (PAS) and the functional oral intake scale (FOIS). The results showed that I&I test had a high sensitivity (0.89) and specificity (0.93) for identify dysphagia in persons with neurologic disorders, with an area under ROC curve of 0.97. Significant differences were found from the comparison between I&I test scores and the three severity levels of PAS. In conclusion, the I&I test is a useful scale to detect the major deficits affecting the cranial nerves in patients with swallowing disorders. In addition, it allows defining the pathophysiological dysphagia symptoms, which are fundamental for planning the customized rehabilitation interventions.