Fiberoptic Endoscopic Evaluation of Dysphagia to Identify Silent Aspiration

Leder, Steven B.; Sasaki, Clarence T.; Burrell, Morton I.

doi:10.1007/pl00009544

Cited by 211 publications

(164 citation statements)

References 13 publications

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“…FEES is particularly suited to the burn population and may be the preferred procedure during the acute phase following burn injury due to its ability to assess sensory impairment, edema, erythema and ulceration of pharyngeal and laryngeal structures caused by concomitant inhalation injury, and its ability to be carried out at bedside when mobility and positioning are compromised by pain, splints and contractures 11 . Furthermore, FEES is repeatable, which caters for the long recovery process for burn patients and allows for assessment of vocal cord integrity and function, which can be affected by endotracheal intubation and inhalation injury 53 .…”

Section: Resultsmentioning

confidence: 99%

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

et al. 2011

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1 This project was supported by funding from the Royal Brisbane and Women's Hospital (RBWH) Foundation. 2 Physiological characteristics of dysphagia following thermal burn injury 3 AbstractThe study aim was to document the acute physiological characteristics of the swallowing impairment following thermal burn injury. A series of 19 participants admitted to a specialised burn centre with thermal burn injury were identified with suspected aspiration risk by a clinical swallow examination (CSE) conducted by a speech-language pathologist and referred to the study. Once medically stable, each then underwent more detailed assessment using both a CSE and a fiberoptic evaluation of swallowing (FEES). Subsequent to this assessment, FEES confirmed 6 individuals (32%) had no aspiration risk, and were excluded from further analyses. Of the remaining 13, CSE confirmed two had specific oral phase deficits due to orofacial scarring and contractures, and all 13 had generalised oromotor weakness. FEES revealed numerous pharyngeal phase deficits with major finding evident in greater than 50% being: impaired secretion management, laryngotracheal edema, delayed swallow initiation, impaired sensation, inadequate movement of structures within the hypopharynx and larynx, and diffuse pharyngeal residue. Penetration and/or aspiration occurred in 83% (n = 10/12) of thin fluids trials, with a lack of response to the penetration/aspiration noted in 60% (n = 6/10 penetration/aspiration events) of cases. Most events occurred post swallow. Findings support that individuals with dysphagia post thermal burn present with multiple risk factors for aspiration that appear predominantly related to generalised weakness and inefficiency and further impacted by edema and sensory impairments. Generalised oromotor weakness and orofacial contractures (when present) impact oral stage swallow function. This study has identified a range of factors which may be contributing to both oral and pharyngeal stage dysfunction in this clinical population and highlights the 4 importance of using a combination of clinical and instrumental assessment to fully understand the influence of burn injury on oral intake and swallowing.

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Section: Resultsmentioning

confidence: 99%

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

et al. 2011

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“…The identification of aspiration is critical to rehabilitation planning for the individual with dysphagia. Numerous aspiration detection technologies along with accompanying clinical screening procedures have been proposed in the literature (see [1] for a review), including, for example, fiberoptic endoscopy [12], pulse oximetry [13], electroglottography (EGG) [14], cervical auscultation with pharyngeal microphone [15], and the present-day gold standard, the modified barium swallow using videofluoroscopy [10]. There is, however, a practical need for a noninvasive, economical, and portable method for detecting aspiration [16] at the bedside and outside of the institutional setting.…”

Section: B Detection Of Aspirationmentioning

confidence: 99%

Investigating the stationarity of paediatric aspiration signals

Chau

Casas

et al. 2005

IEEE Trans. Neural Syst. Rehabil. Eng.

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“…8 -11 Several studies showed that FEES is equal to or even better than videofluoroscopy (VF) in detecting aspiration and severity of residues. [12][13][14][15][16] Preliminary evidence also suggests FEES guided dietary and behavioral management to result in a better outcome of acute stroke patients compared to a management guided by VF. 13 Moreover, in the acute care of stroke patients, FEES has the advantages that it can be performed at bedside, is repeatable as often as necessary, allows evaluation of both the motor and sensory component of swallowing, and permits assessment of airway protection.…”

mentioning

confidence: 99%

The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients

Warnecke

Teismann

Oelenberg

et al. 2009

Stroke

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Background and Purpose-Fiberoptic endoscopic evaluation of swallowing (FEES) is an excellent method for the accurate examination of swallowing function in the acute phase of stroke. The present study investigates the safety of FEES related to patients characteristics in a setting of acute stroke care. Methods-A prospective study of FEES-associated complications was carried out in 300 acute stroke patients over a 1-year period. A neurologist and a speech-language pathologist of the stroke unit team performed FEES within a mean time interval of 1.9Ϯ0.8 days after stroke onset. A closely meshed monitoring of cardiovascular parameters was done during each examination. A discomfort rating was obtained from the patients. Results-In none of the 300 subjects any airway comprise, decrease in the level of consciousness, symptomatic bradycardia/tachycardia, laryngospasm, or epistaxis requiring special treatment was observed. The incidence of self-limiting nosebleeds was 6% and did not significantly differ in relation to major stroke types (ischemic versus hemorrhagic), acute treatment strategy (thrombolysis versus no thrombolysis), or secondary prevention regime (anticoagulant therapy versus antiplatelet drugs). Whereas no alterations in diastolic blood pressure were noted, statistically significant changes in systolic blood pressure, heart rate, and oxygen saturation occurred. However, these alterations did not cause any severe adverse event and were clinically judged as being mild. The assessment of comfort revealed an excellent tolerance of FEES in Ͼ80% of patients. Conclusion-This study demonstrates that FEES is a well-tolerated and safe method to assess swallowing function when performed by a speech-language pathologist and a neurologist in a stroke unit setting.

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Fiberoptic Endoscopic Evaluation of Dysphagia to Identify Silent Aspiration

Cited by 211 publications

References 13 publications

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

Physiological Characteristics of Dysphagia Following Thermal Burn Injury

Investigating the stationarity of paediatric aspiration signals

The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients

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