Abstract
The aim of this study was to compare selected parameters of two swallow evaluations: fiberoptic endoscopic evaluation of swallowing (FEES) and the modified barium swallow (MBS) study. This was a cross-sectional, descriptive study. Fifty-five clinicians were asked to watch video recordings of swallow evaluations of 2 patients that were done using fluoroscopy and endoscopy simultaneously. In a randomized order, clinicians viewed 4 edited videos from simultaneous evaluations: the FEES and MBS videos of patient 1 and 2 each taking one swallow of 5 mL applesauce. Clinicians filled out a questionnaire that asked (1) which anatomical sites they could visualize on each video, (2) where they saw pharyngeal residue after a swallow, (3) their overall clinical impression of the pharyngeal residue, and (4) their opinions of the evaluation styles. Clinicians reported a significant difference in the visualization of anatomical sites, 11 of the 15 sites were reported as better-visualized on the FEES than on the MBS video (p < 0.05). Clinicians also rated residue to be present in more locations on the FEES than on the MBS. Clinicians’ overall impressions of the severity of residue on the same exact swallow were significantly different depending on the evaluation type (FEES vs. MBS for patient 1 χ2 = 20.05, p < 0.0001; patient 2 χ2 = 7.52, p = 0.006), with FEES videos rated more severely. FEES advantages were: more visualization of pharyngeal and laryngeal swallowing anatomy and residue. However, as a result, clinicians provided more severe impressions of residue amount on FEES. On one hand, this suggests that FEES is a more sensitive tool than MBS studies, but on the other hand, clinicians might provide more severe interpretations on FEES.
Similar content being viewed by others
References
Kidder T, Langmore S, Martin B. Indications and techniques of endoscopy in evaluation of cervical dysphagia: comparison with radiographic techniques. Dysphagia. 1994;9:256–61.
Aviv JE. Prospective, randomized outcome study of endoscopy vs. modified barium swallow in patients with dysphagia. Laryngoscope. 2000;100:563–74.
Langmore SE, Schatz K, Olsen N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100:678–81.
Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107:396–401.
Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia. 1998;13:19–21.
Rao N, Brady S, Chaudhuri G, Donzelli J, Wesling M. Gold standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations. J App Res. 2003;3:89–96.
Kelly AM, Leslie P, Beale T, Payten C, Drinnan MJ. Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity? Clin Otolaryngol. 2006;31(5):423–5.
Langmore SE. Endoscopic evaluation of oral and pharyngeal phases of swallowing. GI Motility. 2006; online 16 May. doi:10.1038/gimo28.
Brady S, Donzello J. The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol Clin North Am. 2013;46(6):1009–22.
Nordally SO, Sohawon S, DeGieter M, Bellout H, Verougstraete G. A study to determine the correlation between clinical, fiber-optic endoscopic evaluation of swallowing and videofluoroscopic evaluations of swallowing after prolonged intubation. Nutr Clin Pract. 2011;26(4):457–62.
Willging JP, Miller CK, Hogan MJ, Rudolph CD. Fiberoptic endoscopic evaluation of swallowing in children: a preliminary report of 100 procedures. Dysphagia. 1996;11(2):162.
Wu CH, Hsiago TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluroscopic technique. Laryngoscope. 1997;107:396–401.
Kaye GM, Zoroqitz RD, Baredes S. Role of flexible laryngoscopy in evaluating aspiration. Ann Otol Rhinol Laryngol. 1997;106:705–9.
Perie S, Laccourreye L, Flahault A, Hazebroucq V, Chaussade S, St Guily JL. Role of videoendoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope. 2000;110:563–74.
Madden C, Fenton J, Hughes J, Timon C. Comparison between videofluroscopy and milk-swallow endoscopy in the assessment of swallowing function. Clin Otolaryngol. 2000;25:504–6.
Kelly AM. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117:1723–7.
Portney LG, Watkins MP. Foundations of clinical practice: applications to practice. 3rd ed. Upper Saddle River: Prentice Hall Health; 2009 (ISBN: 9780131716407).
Saldaña J. The coding manual for qualitative researchers. Thousand Oaks: Sage; 2012.
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Balir J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23:392–405.
Hind JA, Gensler G, Brandt DK, et al. Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia. 2009;24(2):211–7. doi:10.1007/s00455-008-9196-6.
Gerek M, Atalay A, Cekin E, Ciyiltepe M, Ozkaptan Y. The effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia. Kulak Burun Bogaz Ihtis Derg. 2005;15(5–6):103–11.
Perlman AL, Grayhack JP, Booth BM. The relationship of vallecular residue to oral involvement, reduced hyoid elevation, and epiglottic function. J Speech Hear Res. 1992;35:734–41.
Molfenter SM, Steel CM. The relationship between residue and aspiration on the subsequent swallow: an application of the Normalized Residue Ratio Scale. Dysphagia. 2013;29:494–500.
Butler SG, Markley L, Sanders B, Stuart A. Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing. Ann Oto Rhinol Laryngol. 2015;124(6):480–3.
Hey C, Pluschinski P, Pajunk R, Almahameed A, Girth L, Sader R, Stöver T, Zaretsky Y. Penetration–aspiration: is their detection in FEES reliable without video recording? Dysphagia. 2015;30:418–22.
Neubauer PD, Rademaker AW, Leder SB. The Yale pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia. 2015;. doi:10.1007/s00455-015-9631-4.
Kaneoka A, Langmore SE, Krisciunas GP, Field K, Scheel R, McNally E, Walsh MJ, O’Dea MB, Cabral H. The Boston residue and clearance scale: preliminary reliability and validity testing. Folia Phoniatrica et Logopaedica. 2013;65:312–7.
Zraick RI, Kempster GB, Conner NP, Klaben BK, Bursac Z, Thrush CR, Glaze LE. Establishing validity of the consensus auditory-perceptual evaluation of voice (CAPE-V). Am J Speech-Lang Pathol. 2011;20:14–22.
Nacci A, Ursino F, La Vela R, Matteucci F, Mallardi V, Fattori B. Fiberoptic endoscopic evaluation of swallowing (FEES): proposal for informed consent. Acta Otorhinolaryngol Ital. 2008;28(4):206–11.
Pearson WG Jr, Molfenter SM, Smith Z, Steele CM. Image-based measurement of post-swallow residue: the normalized residue ratio scale. Dysphagia. 2013;. doi:10.1007/s00455-012-9426-9.
Jung SH, Kim J, Jeong H, Lee SU. Effect of the order of test diets on the accuracy and safety of swallowing studies. Ann Rehabil Med. 2014;38(3):304–9.
Fuller SC, Leonard R, Aminpour S, Belafsky PC. Validation of the pharyngeal squeeze maneuver. otolaryngol. Head Neck Surg. 2009;140:391–4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Pisegna, J.M., Langmore, S.E. Parameters of Instrumental Swallowing Evaluations: Describing a Diagnostic Dilemma. Dysphagia 31, 462–472 (2016). https://doi.org/10.1007/s00455-016-9700-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-016-9700-3