A comparison of assessment findings using videofluoroscopy and fibreoptic endoscopic evaluation of swallowing safety

Abstract

Videofluoroscopic assessment (VF) is the most widely used objective assessment technique for the assessment of dysphagia, but many will acknowledge that the procedure has some limitations. Fibreoptic endoscopic evaluation of swallowing safety (FEESS) was developed in an attempt to provide an adjunct to VF and to meet some of its limitations. It is essentially an extension of the routine fibreoptic examination of the larynx and pharynx used by ENT consultants, in which the patient is given various textures to swallow and observations about swallow events and overall swallowing efficiency can be made. The literature includes several studies comparing results of these two procedures and outlining their relative advantages and disadvantages, but no one has looked at a wide range of swallow events and directly compared results obtained. Before introducing the procedure it was felt that it would be useful to evaluate it with our specific neurogenic population. The questions to be asked in our study were: (1) Do patients tolerate the procedure comfortably enough to make it a valid tool for the assessment of swallowing? Specifically, how many patients tolerate the fibreoptic endoscope in position for the average of 10 minutes which is required? (2) Does the procedure allow us to identify significant swallow events identified with VF?(3) What information, if any, is provided by FEESS that VF does not provide? The study involved 20 neurogenic patients with dysphagia, who were routinely referred to Neuro‐otology for assessment of laryngeal function and who reported swallowing difficulties. All the patients were known to the speech and language therapy department. An extended fibreoptic assessment of palatal, pharyngeal and laryngeal function, and trial swallows of various textures, was carried out within one week of FEESS and involved trial swallows of similar textures to those used in FEESS in lateral and AP views. Facilitators were trialled. Results were collected and recorded in relation to individual swallow events, for example, amount of tongue base retraction, triggering of swallow reflex, and evaluation of facilitators. Analysis of results is incomplete at this stage. Eighteen of the 20 patients tolerated FEESS assessment tasks. However, only eight of the 18 patients tolerated Mailing of facilitators, in particular those involving head positioning. Preliminary results revealed that oral stage events are better evaluated with VF. Nasal regurgitation is identified equally on VF and DEESS. Delay in triggering of the swallow reflex is identified equally with both procedures, but it is possible to obtain objective times with VF. Pharyngeal swallow events are not visualised with FEESS, but residual pharyngeal pooling was clearly visualised and amounts of residue more easily estimated. Aspiration was identified reliably with both procedures. Full results will be presented. Conclusions at this point support those suggested in the literature that FEESS is a useful adjunct to VF and may, in fact, be the assessment te...