Modified endoscopic swallowing test for improved diagnosis and prevention of aspiration

Abstract

Laryngopharyngeal sensation is important in the normal process of swallowing, it is often impaired after neurological events and it has been common practice in such an occurrence to order non-oral tube feeding to prevent aspiration. This study assesses a novel approach to the evaluation of the laryngopharyngeal sensation that allows for improved triage of aspiration risk and more lenience towards oral feeding. This is a case series with follow-up period ranging from 6 to 24 months. Forty patients with neurological deficiencies were tested by a modified laryngopharyngeal sensation study that included evaluation of both supra and infra-glottis. All patients had impaired supra glottic sensation but had good infra glottic sensation that enabled cough protection. All had received oral feeding. Main outcome measure is incident aspiration pneumonia. Twenty-two patients maintained oral feeding without any evidence of aspiration. Eighteen patients had some aspirations associated with cough, and were maintained on modified oral feeding. Out of these 18 patients, four patients (10% of the entire group) developed aspiration pneumonia. The presented procedure identified patients with impaired supraglottic sensation but preserved good infra glottic sensation. This observation enables safe oral feeding in most patients and therefore offers a better quality of life for these individuals.

Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients

“…FEES has been shown to be safe and effective for assisting in swallowing evaluation, and in therapy as a visual display to help patients learn various swallowing manoeuvres. [ 4 , 10 – 13 ]. It can be used in a wide variety of settings, ranging from office evaluation of swallowing, inpatient and outpatient services to critically ill patient treated at the ICU [ 14 – 20 ].…”

Involvement of the epithelial sodium channel in initiation of mechanically evoked swallows in anaesthetized rats

“…Various non-noxious stimuli, including mechanical, taste and thermal stimuli, may be involved in natural swallowing. Many researchers have reported that impaired laryngeal mechanosensation is associated with the occurrence of aspiration of food boluses and aspiration pneumonia in patients with dysphagia (Kidd et al 1993;Aviv et al 1997;Flaksman et al 2006;Onofri et al 2014). Setzen et al (2003) reported that severe pharyngolaryngeal sensory deficits were associated with aspiration of thin liquids regardless of the integrity of pharyngeal motor function.…”

A Study to Determine the Correlation Between Clinical, Fiber‐Optic Endoscopic Evaluation of Swallowing and Videofluoroscopic Evaluations of Swallowing After Prolonged Intubation

“…Our results are consistent with those from several clinical investigations that also indicate that FEES is effective for swallowing evaluation. 5 , 12 However, FEES still remains an invasive procedure. We showed that a clinical examination assessing the pharyngeal phase with swallowing can be used as an initial test when FEES and videofluoroscopy are not available in detecting postextubation swallowing disorders.…”

“…FEES allows visualization of the pharyngeal phase of swallowing and may be performed easily at the bedside but depends on the availability of an experienced endoscopist. 5 , 12 …”