Flexible Endoscopic Evaluation Research Articles

Dysphagia and tracheostomy management in New Zealand intensive care units

ABSTRACT Background: Speech-language therapists (SLTs) hold an important multidisciplinary team (MDT) role in managing swallowing, communication and tracheostomy weaning in intensive care units (ICUs). Yet, many ICUs do not have dedicated SLT time. In this study, we explored New Zealand ICU’s current practices to support benchmarking across the country and against international evidence-based practice. Methods: In part 1, we extracted New Zealand data representing 11 ICU MDTs across all regions from an international survey of 746 ICUs (26 countries). MDTs were asked about their dysphagia practice. In part 2, we conducted a national survey exploring tracheostomy practice in New Zealand. SLTs were asked about perceived roles, knowledge, skills and confidence in tracheostomy. Thirty-five SLTs responded to the survey, again, representing all New Zealand regions. Results: All ICUs had access to a SLT but none had dedicated SLT hours. ICU teams had variable awareness of evidence-based practice in dysphagia care. Swallowing rehabilitation was infrequent. The top two perceived barriers to standardized management of dysphagia were lack of access to SLT and flexible endoscopic evaluation of swallowing (FEES) equipment. In part 2, SLTs were experienced and confident but standardized protocols were infrequent and not all practices met current international evidence-based practice. SLTs’ reported barriers to best practice were MDT understanding of role, insufficient ICU-dedicated SLTs, training of nursing, and access to otolaryngology. Conclusions: Skilled, ICU-dedicated SLTs are needed in New Zealand ICUs to support more consistent and evidence-based practice. Access to FEES and time for rehabilitation and MDT education are needed.

Risk and predictive factors of oral feeding skills disorder in preterm infants: an observational study using flexible endoscopic evaluation of swallowing

Risk and predictive factors of oral feeding skills disorder in preterm infants: an observational study using flexible endoscopic evaluation of swallowing

Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES).

The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs=0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.

Post-Extubated Dysphagia in Intensive Care Unit Patients Based on Flexible Endoscopic Evaluation of Swallowing Examination and Its Affecting Factors

Background and Objectives Post-extubation dysphagia (PED) is a condition characterized by swallowing difficulty following the removal of breathing tube. Untreated dysphagia leads to increased morbidity and mortality; however, no study has been conducted on the proportion of PED at RSUPN Dr. Cipto Mangunkusumo (RSCM), using flexible endoscopic evaluation of swallowing (FEES), or on the factors that contribute to its occurrence.Subjects and Method Anamnesis and medical record review were conducted on post-extubation patients in the RSCM intensive care unit (ICU) meeting inclusion criteria. Research subjects underwent maximum phonation time (MPT) examination thrice. FEES examination was carried out twice, with 24 hours of post-extubation on all subjects and 72 hours of postextubation on those with PED on initial FEES examination.Results The study involved 33 subjects who met the inclusion criteria. The proportion of mild to severe PED determined by FEES 24 hours after extubation was 66.7%, and those exhibiting laryngeal injury was 87.9%. The bivariate analysis revealed a significant correlation between the number of comorbidities, intubation duration, laryngeal injury severity, and MPT value with the incidence of PED in the RSCM ICU. Moreover, the multivariate analysis showed that the duration of intubation exceeding 24 hours had a statistically significant association with the incidence of PED (&lt;i&gt;p&lt;/i&gt;=0.003; OR 15.30; 95% CI 2.46-95.19).Conclusion The proportion of mild to severe dysphagia in post-extubation patients in the RSCM ICU is quite high. Intubation duration exceeding 24 hours and having more than one comorbidity significantly contribute to the increased risk of dysphagia in post-extubated patients in the RSCM ICU.

Analysis of Supraglottic Activity during Vocalization in Flamenco Singers.

Flamenco is a traditional music originally from Andalusia in southern Spain. Some of the vocal resources used in Flamenco have components of voice distortion and other voice qualities that could sound like hyperfunctional voice productions. The present study aimed at observing supraglottic activity in flamenco singers while engaged in singing at various degrees of pitch and loudness and while engaged in realizing phonatory tasks. A total of eighteen flamenco singers with at least 5 years of voice training were recruited. Flexible endoscopic voice evaluations were recorded and edited to provide samples of different pitches, loudness levels, and phonatory tasks. Sound was removed from video samples. Two blinded laryngologists were asked to assess antero-posterior compression, medial compression, pharyngeal compression, and VLP for every sample, using a visual analog scale. Significantly higher values were found for medial compression, anterior-posterior compression, VLP and pharyngeal compression during high loudness levels when compared to medium and low loudness. Overall, medial compression was lower than anterior-posterior compression. Supraglottic activity is present in flamenco singing in the four laryngoscopic variables. It seems to be that supraglottic activity increases with loudness level and pitch. This behavior could be a natural and necessary aspect of flamenco singing present during both sustained vowels and song.

The effect of underlying diseases on pneumonia risk in patients with neurogenic or tumor-related dysphagia: a retrospective cohort study.

To analyze the association of neurological disorders (ND) and head and neck cancer (HNC) with dysphagia severity and aspiration pneumonia occurrence. Retrospective cohort study conducted at a university dysphagia center) for two consecutive years. Patients with ND or HNC were included if they had undergone a flexible endoscopic swallowing evaluation (FEES) at the dysphagia center, and at least one food consistency had been sampled and recorded. Outcomes of interest were swallowing safety, highest penetration-aspiration-score (PASmax), way of food intake, presence of a tracheal tube, and occurrence of pneumonia within the past two years. Of 257 consecutive patients, 199 were enrolled in the study and classified according to their underlying diagnosis into ND (120 patients) or HNC (79 patients). Forty-three HNC patients (54.4%) and 54 ND patients (45%) showed critical dysphagia in FEES (PAS ≥ 6). Binary logistic regression comparing both groups showed patients with ND to be 2.31 times more likely to develop pneumonia. However, if the 32 stroke patients were excluded from the calculation, PASmax remains the only significant variable affecting pneumonia risk in both groups. Liquids were the main challenge for ND patients, while aspirating HNC patients struggled with all consistencies. The study shows that patients with HNC and ND differ in pneumonia risk only if stroke patients are included in the ND group. If they are excluded, the PAS score is the only remaining risk factor for pneumonia. Thickening liquids may not be suitable for all dysphagic patients; individually tailored measures might be more helpful, especially for HNC patients.

Assessment of swallowing dysfunction using fees (flexible endoscopic evaluation of swallowing) in head and neck cancer patients undergoing radiotherapy

Assessment of swallowing dysfunction using fees (flexible endoscopic evaluation of swallowing) in head and neck cancer patients undergoing radiotherapy

Screening of Palatopharyngeal Incoordination in Mechanically Ventilated Critically Ill Infants

Abstract Background Palatopharyngeal incoordination is a common phenomenon in patients requiring endotracheal intubation for mechanical ventilation. Understanding the underlying mechanism of palatopharyngeal incoordination may help as a screening tool that improves rates of early recognition and diagnosis and the ability to take preventive measures essential to alleviate related morbidity and complications. Objective The aim of this study is to screen palatopharyngeal incoordination in infants who needed mechanical ventilation and to elicit palatopharyngeal incoordination secondary to mechanical ventilation. Material and Methods This study included 51 patients at the Pediatric Intensive Care Unit, Faculty of Medicine, Ain Shams University, The study was conducted during the period from February 2021 to February 2022. patients were classified according to a Fiberoptic Flexible Endoscopic Evaluation of Swallowing (FEES) early post intubation, FEES early post extubation, Videofluoroscopic Swallow Study (VFSS) post extubation and dye study into five groups: group (1) the not affected group, group (2) the palatopharyngeal incoordination group, group (3) The palatopharyngeal incoordination with gastro esophageal reflux group, group (4) The reflux group, group (5) The congenital upper air way anomalies group in which patients were ventilated due to respiratory distress. Follow up FEES and VFSS were done after three months for palatopharyngeal incoordination patients. Results Palatopharyngeal incoordination was detected in 16 patients (31.3%), congenital upper airway anomalies were found in 12 patients (23.5%), and gastroesophageal reflux was only detected in 10 patients (19.6%). Performing VFSS and FEES after three months showed 92.3 % of palatopharyngeal incoordination patients had resolved palatopharyngeal incoordination and 7.7 % of palatopharyngeal incoordination patients had silent aspiration. Conclusion The prevalence of palatopharyngeal incoordination is 31.3 % and there was no palatopharyngeal incoordination secondary to mechanical ventilation.

Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke.

Swallowing is a complex task, moderated by a sophisticated bilateral network including multiple supratentorial regions, the brainstem and the cerebellum. To date, conflicting data exist about whether focal lesions to the cerebellum are associated with dysphagia. Therefore, the aim of the study was to evaluate dysphagia prevalence, recovery and dysphagia pattern in patients with ischaemic cerebellar stroke. A retrospective analysis of patients consecutively admitted to an academic stroke centre with ischaemic stroke found only in the cerebellum was performed. The presence of dysphagia was the primary end-point and was assessed by a speech-language pathologist, according to defined criteria. Dysphagia pattern was evaluated by analysing the videos of the flexible endoscopic evaluation of swallowing. Brain imaging was used to identify lesion size and location associated with dysphagia. Between January 2016 and December 2021, 102 patients (35.3% female) with a mean age of 52.8 ± 17.3 years were included. Thirteen (12.7%) patients presented with dysphagia. The most frequently observed flexible endoscopic evaluation of swallowing phenotype was premature spillage (n = 7; 58.3%), whilst significant residues or aspiration did not occur. One patient died (7.7%); the other patients showed improvement of dysphagia and one patient (7.7%) was discharged with dietary restrictions. Although the involvement of the cerebellum in deglutition has become increasingly evident, isolated lesions to the cerebellum are less likely to cause clinically relevant and persisting dysphagia compared to other brain regions. The observed dysphagia pattern shows a lack of coordination and control, resulting in premature spillage or fragmented bolus transfer in some patients.

Swallowing muscle mass contributes to post-stroke dysphagia in ischemic stroke patients undergoing mechanical thrombectomy.

Neurogenic dysphagia is a frequent complication of stroke and is associated with aspiration pneumonia and poor outcomes. Although ischaemic lesion location and size are major determinants of the presence and severity of post-stroke dysphagia, little is known about the contribution of other acute stroke-unrelated factors. We aimed to analyse the impact of swallowing and non-swallowing muscles measurements on swallowing function after large vessel occlusion stroke. This retrospective study was based on a prospective registry of consecutive ischaemic stroke patients. Patients who underwent mechanical thrombectomy between July 2021 and June 2022 and received a flexible endoscopic evaluation of swallowing (FEES) within 5days after admission were included. Demographic, anthropometric, clinical, and imaging data were collected from the registry. The cross-sectional areas (CSA) of selected swallowing muscles (as a surrogate marker for swallowing muscle mass) and of cervical non-swallowing muscles were measured in computed tomography. Skeletal muscle index (SMI) was calculated and used as a surrogate marker for whole body muscle mass. FEES parameters, namely, Functional Oral Intake Scale (FOIS, as a surrogate marker for dysphagia presence and severity), penetration aspiration scale, and the presence of moderate-to-severe pharyngeal residues were collected from the clinical records. Univariate and multivariate ordinal and logistic regression analyses were performed to analyse if total CSA of swallowing muscles and SMI were associated with FEES parameters. The final study population consisted of 137 patients, 59 were female (43.1%), median age was 74years (interquartile range 62-83), median baseline National Institutes of Health Stroke Scale score was 12 (interquartile range 7-16), 16 patients had a vertebrobasilar occlusion (11.7%), and successful recanalization was achieved in 127 patients (92.7%). Both total CSA of swallowing muscles and SMI were significantly correlated with age (rho=-0.391, P<0.001 and rho=-0.525, P<0.001, respectively). Total CSA of the swallowing muscles was independently associated with FOIS (common adjusted odds ratio=1.08, 95% confidence interval=1.01-1.16, P=0.029), and with the presence of moderate-to-severe pharyngeal residues for puree consistencies (adjusted odds ratio=0.90, 95% confidence interval=0.81-0.99, P=0.036). We found no independent association of SMI with any of the FEES parameters. Baseline swallowing muscle mass contributes to the pathophysiology of post-stroke dysphagia. Decreasing swallowing muscle mass is independently associated with increasing severity of early post-stroke dysphagia and with increased likelihood of moderate-to-severe pharyngeal residues.

Discrepant Results of Flexible Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopy Swallowing Study (VFSS) in Myasthenia Gravis’ Patient

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that causes weakness in skeletal muscles. Dysphagia is an early symptom that is often found in 6-15% of patients with myasthenia gravis. Flexible Endoscopic Evaluation of Swallowing (FEES) and Video Fluoroscopic Swallowing Study (VFSS) examinations are routinely used to diagnose dysphagia. This paper reports a case of Male, 51 years old diagnosed with neurogenic oropharyngeal dysphagia due to MG. Swallowing evaluation post-therapy and rehabilitation programs were carried out. Interestingly both FEES and VFSS had a significant discrepant result. In cases of dysphagia due to MG, when interpreting objective swallowing function examination, confounding factors such as fatigue, timing of examinations, and time of taking medication specifically anticholinesterase (Pyridostigmine), should be taken into consideration.

Diet Outcomes in Patients With COVID-19 Who Were Intubated and Proned

Objective: During the first wave of the COVID-19 (SARS CoV-2) pandemic, patients being treated for acute respiratory distress syndrome were proned while intubated with mechanical ventilation. In this study, we aimed to compare the diet outcomes at the time of acute hospital discharge of patients with COVID-19 who were proned while endotracheally intubated (ETT-proned) with those who were intubated with but not proned (ETT-supine). Design: The design used is a single-center, retrospective, descriptive study. Results: Between March 1, 2020, and August 2020, 193 critically ill adult patients with severe COVID-19 requiring endotracheal intubation with mechanical ventilation were referred for a swallowing evaluation at our acute care tertiary hospital; 114 of these patients were ETT-proned. At the time of discharge from the hospital, there was no significant difference in diet level between ETT-proned and ETT-supine patients. Significant factors associated with restricted diet at discharge included older age ( p &lt; .001) and non–English-speaking status ( p = .05). Conclusions: In this study, diet levels at the time of discharge did not differ significantly between the patient groups by time of discharge. These results should be interpreted with caution in relation to the clinical swallow evaluation, which was curtailed by practice restrictions imposed by pandemic protocols. Future research should objectively assess swallow function in patients who were proned during intubation with mechanical ventilation, utilizing evidence-based swallow screening protocols, standardized assessment of physiology via imaging (videofluoroscopic swallow studies or flexible endoscopic evaluation of swallowing), and long-term follow-up to directly and objectively determine the impact proning has on swallow physiology.

Cough effectiveness during airway invasion in adults with oropharyngeal dysphagia: A systematic review of literature

BACKGROUND: Cough and swallowing share common neuroanatomic pathways, leading to an overlap between their mechanisms. Despite the widely recognised role of cough as an airway defence mechanism, empirical evidence supporting its effectiveness for airway clearance is lacking. OBJECTIVE: This review summarises and appraises available evidence regarding the effectiveness of cough in response to airway penetration and/or aspiration during videofluoroscopic swallow study (VFSS) or flexible endoscopic evaluation of swallowing (FEES) in adults with oropharyngeal dysphagia (OD) of any aetiology. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed. Literature search was conducted in March 2023 and updated in March 2024 across six databases without publication status, language, or date restrictions. Two independent reviewers performed screening, with disagreements resolved through consensus and majority vote. The principal investigator conducted data extraction and quality appraisal using the Downs and Black checklist. RESULTS: Of 6,049 studies retrieved, 25 met the eligibility criteria. Due to heterogeneous reporting, a summary of participant demographics could not be compiled. Absence of a standardised method for measuring cough effectiveness meant meta-analysis was impossible. Nonetheless, an effective cough response to penetration/aspiration was noted for some participants within 17 studies, ineffective cough responses for some within 17 studies, while one study reported a partially effective cough response for participants. CONCLUSIONS: Robust evidence on cough effectiveness is lacking due to study heterogeneity and inconsistent reporting. Developing a standardised tool to assess cough effectiveness would ensure consistency and comparability across studies, improving clinical reporting of VFSS and FEES outcomes.

Validity and Reliability of the Swedish Version of the Gugging Swallowing Screen for use in Acute Stroke Care.

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29-93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78-0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

Which Provider Specialties are Performing Diagnostic Procedures for Dysphagia in the United States?

Care of patients with dysphagia occurs at the intersection of several different medical specialties. Otolaryngologists are uniquely equipped to diagnose dysphagia given their specialized training, yet the extent to which otolaryngologists perform diagnostic procedures for dysphagia is unknown. The objective of this study was to characterize the specialty-level variation among providers performing diagnostic assessments for dysphagia. We performed a retrospective, cross-sectional analysis of dysphagia care utilization among Medicare beneficiaries from 2013 to 2021 using the CMS Physician & Other Practitioners by Provider and Service dataset. American Association of Medical Colleges (AAMC) data reports were used to determine the total number of providers per specialty. For each procedure and specialty, the percentage of providers performing >10 procedures annually and the average annual number of procedures per performing provider (non-radiology) were calculated. We analyzed nine common dysphagia diagnostic procedures, including manometry, 24-h pH testing, flexible endoscopic evaluation of swallowing (FEES), and modified barium swallow study (MBSS). Mean 3.7 (SD 1.4) otolaryngologists (0.04% of practicing) performed manometry testing annually, compared to 493 (69.3) gastroenterologists (3.3%). Less than 1% of practicing otolaryngologists (37.8 (8.0) (0.04%)) and gastroenterologists (51.6 (8.4), 0.35%) performed 24-h pH testing annually. FEES testing was most commonly performed by otolaryngologists; however, only 48 (6.3) providers (0.51% of practicing) performed these procedures annually. For MBSS, fewer otolaryngologists (5.2 (1.0), 0.05%) perform these assessments than other medical specialties. Each otolaryngologist performed 110.7 (52.5) studies annually, compared to 200.1 (68.0) per gastroenterologist. Otolaryngologists represent a small fraction of providers performing dysphagia-related diagnostic procedures despite a unique training within our specialty to comprehensively diagnose and manage this condition. 3 Laryngoscope, 134:3698-3705, 2024.

Swallowing Characteristics and Water Swallow Capacity in Patients with Parkinsonism.

Prevalence and characteristics of dysphagia (including aspiration) in patients with parkinsonism is variable, depending on type of assessment, diagnosis, disease stage and duration. The aim of this study was to further evaluate dysphagia characteristics in patients with different types of parkinsonism with both instrumental (Flexible Endoscopic Evaluation of Swallowing, FEES) and non-instrumental (Timed Water Swallow Test, TWST) assessments. Swallowing characteristics in 74 patients with parkinsonism were prospectively assessed using FEES and TWST. Statistics employed were (a) Spearman rank correlation to measure correlation between dysphagia results and Parkinson subtypes, disease severity and duration and (b) the non-parametric tests Mann Whitney U and Kruskal Wallis to measure difference between groups. Dysphagia was common, with 50 (67.6%) of the patients demonstrating a mild-severe Dysphagia Outcome Severity Scale (DOSS, level 1-5). During FEES, 42% aspirated and 68% of these had silent aspiration. Aspiration was seen more frequently with increased disease severity as per Hoehn and Yahr (H&Y) (r = .459, p = < 0.001) and disease duration (r = .269, p = .021). Thin liquid (IDDSI level 0) was the most common consistency to aspirate, and the frequency of aspiration decreased with thicker liquids. Dysphagia and aspiration are common in all subgroups of parkinsonism and seen in early stages of H&Y and within the first year of disease duration. Hence, it is recommended that these patients are evaluated early for optimal management and to avoid aspiration-related complications.

Advancements and Challenges in Non-Invasive Sensor Technologies for Swallowing Assessment: A Review.

Dysphagia is a pervasive health issue that impacts diverse demographic groups worldwide, particularly the elderly, stroke survivors, and those suffering from neurological disorders. This condition poses substantial health risks, including malnutrition, respiratory complications, and increased mortality. Additionally, it exacerbates economic burdens by extending hospital stays and escalating healthcare costs. Given that this disorder is frequently underestimated in vulnerable populations, there is an urgent need for enhanced diagnostic and therapeutic strategies. Traditional diagnostic tools such as the videofluoroscopic swallowing study (VFSS) and flexible endoscopic evaluation of swallowing (FEES) require interpretation by clinical experts and may lead to complications. In contrast, non-invasive sensors offer a more comfortable and convenient approach for assessing swallowing function. This review systematically examines recent advancements in non-invasive swallowing function detection devices, focusing on the validation of the device designs and their implementation in clinical practice. Moreover, this review discusses the swallowing process and the associated biomechanics, providing a theoretical foundation for the technologies discussed. It is hoped that this comprehensive overview will facilitate a paradigm shift in swallowing assessments, steering the development of technologies towards more accessible and accurate diagnostic tools, thereby improving patient care and treatment outcomes.

Characterizing the Validity of Using VASES to Derive DIGEST-FEES Grades

Introduction: Visual Analysis of Swallowing Efficiency and Safety (VASES) and Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) are two complimentary methods for assessing swallowing during FEES. Whereas VASES is intended to facilitate trial-level ratings of pharyngeal residue, penetration, and aspiration, DIGEST-FEES is intended to facilitate protocol-level impairment grades of swallowing safety and efficiency. The aim of this study was to assess the validity of using VASES to derive DIGEST-FEES impairment grades. Methods: DIGEST-FEES grades were blindly analyzed from 50 FEES – first using the original DIGEST-FEES grading method (n = 50) and then again using a VASES-derived DIGEST-FEES grading method (n = 50). Weighted Kappa (κw) and absolute agreement (%) were used to assess the relationship between the original DIGEST-FEES grades and VASES-derived DIGEST-FEES grades. Spearman’s correlations assessed the relationship between VASES-derived DIGEST-FEES grades with measures of construct validity. Results: Substantial agreement (κw = 0.76–0.83) was observed between the original and VASES-derived grading methods, with 60–62% of all DIGEST-FEES grades matching exactly, and 92–100% of DIGEST-FEES grades within one grade of each other. Furthermore, the strength of the relationships between VASES-derived DIGEST-FEES grades and measures of construct validity (r = 0.34–0.78) were similar to the strength of the relationships between original DIGEST-FEES grades and the same measures of construct validity (r = 0.34–0.83). Conclusion: Findings from this study demonstrate substantial agreement between original and VASES-derived DIGEST-FEES grades. Using VASES to derive DIGEST-FEES also appears to maintain the same level of construct validity established with the original DIGEST-FEES. Therefore, clinicians and researchers may consider using VASES to increase the transparency and standardization of DIGEST-FEES ratings. Future research should seek to replicate these findings and explore the simultaneous use of VASES and DIGEST-FEES in a greater sampling of raters and across other patient populations.

Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy.

This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.

IDDSI-compliant recipes containing oral contrast agents for radiological dysphagia diagnostics.

Videofluoroscopic swallowing study (VFSS), alongside flexible endoscopic evaluation of swallowing, represents the gold standard for diagnosing swallowing disorders and to determine severity, pathophysiology, and effective interventions, including texture modification. The clinical swallowing examination and assessment supplements these instrumental methods and serves as the basis for the modules of swallowing diagnostics. The adaptation of food and drink consistencies in dysphagia management has become widespread. For valid results of a VFSS with respect to confirming swallowing safety and efficiency of different liquid and food consistencies and textures, the use of uniform recipes containing radio-opaque contrast media is important. Our goal was to identify recipes that would produce consistencies that conform to the liquid and food levels of 0-7, as defined by the International Dysphagia Diet Standardization Initiative (IDDSI), with barium- and iodine-based contrast media, xanthan gum-based thickeners, and other edible components, which also show sufficient contrast on VFSS. In this study, we determined the different recipes using IDDSI testing methods and explored their radiological characteristics using a Philips MultiDiagnost Eleva fluoroscopy system and two different fluid contrast agents: barium- (Micropaque®) and iodine-based (Telebrix®). All recipes showed sufficient contrast on fluoroscopy and could be visualized in the amounts used for swallowing examinations. They were practical and easy to implement in terms of production and availability of the components. The homogeneity of the recipes diminished with higher IDDSI levels, which represent transitional food, but appeared still sufficient for fluoroscopic examination. The opacity did not significantly differ between the barium- and iodine-based contrast media.