Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians’ Role in Multidisciplinary and Multiprofessional Dysphagia Management Team

Abstract

The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician’s role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.

Dysphagia Management in Children: Implementation and Perspectives of Flexible Endoscopic Evaluation of Swallowing (FEES)

“…A multidisciplinary, multiprofessional dysphagia team includes pediatricians, pediatric neurologists, pediatric intensivists, otorhinolaryngologists, speech–language pathologists, phoniatricians, pediatric pulmonologists, pediatric surgeons, pediatric gastroenterologists, nutrition specialists, and rehabilitation specialists, who provide coordinated and integrated care with continuity through care transitions. Within the pediatric dysphagia team, the allocation and distribution of tasks are varied and dynamic, determined by different professional developments of medical and healthcare disciplines in different countries and the relevant legal regulations [ 7 , 8 , 22 ]. A collaborative approach to the FEES examination by an otolaryngologist and a speech–language pathologist facilitates the examination and fosters best practices in managing pediatric dysphagia.…”

“…A collaborative approach to the FEES examination by an otolaryngologist and a speech–language pathologist facilitates the examination and fosters best practices in managing pediatric dysphagia. Due to varying national practices and legislation, it is difficult to define generally accepted recommendations [ 22 ]. FEES training opportunities are widely available.…”

“…Especially in the case of medically fragile NICU infants, competency development and training are necessary to establish a multidisciplinary FEES practice [ 18 ]. In many European countries FEES is mainly performed by phoniatricians, for whom dysphagia management is part of their core competence [ 22 ]. Implementing FEES in pediatric dysphagia management requires knowledge of the developmental aspects of feeding, anatomic and physiological changes, and swallowing impairments associated with structural, neurologic, cardiorespiratory, or metabolic conditions.…”

Dynamic Prognostic Score to Predict Survival in East Asian Elderly Populations with Dysphagia

“…However, many healthcare professionals and patients with dysphagia are unaware that dysphagia is treatable [11]. Professionals responsible for the delivery of dysphagia rehabilitation interventions mostly consist of speech and language therapists [12]. Recent studies developed various approaches and procedures for dysphagia such as electrical stimulation therapy, which is widely used as a facilitative rehabilitation strategy to improve dysphagia [13].…”

Strategies of Screening and Treating Post-extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs

“…Limited awareness, and inadequate knowledge are some of the reasons that were attributed to limited screening for PED in the intensive care units (ICUs) [20]. Additionally, although a speech and language pathologist/ therapist (SLP/SLT) is helpful in the evaluation and management of dysphagia [21], dysphagia is a complex problem that requires multi-professional targeted approach [22,23]. Moreover, little evidence showed that assessment and management of dysphagia are conducted by nurses and non-specialists in ICUs [24].…”