Abstract
This study investigated the use of fiberoptic endoscopic evaluation of swallowing (FEES) to both diagnose pharyngeal dysphagia and make treatment recommendations in 17 consecutive patients with a new diagnosis of amyotrophic lateral sclerosis (ALS) and complaints of dysphagia. Ten of 17 (59%) patients exhibited pharyngeal dysphagia with aspiration or aspiration risk with clear liquids, i.e., 5 of 8 (63%) limb and 5 of 9 (56%) bulbar. If depth of bolus flow was a problem, thickened liquids and single, small bolus sizes were recommended. If bolus retention was a problem, a small clear liquid bolus after each puree or solid bolus was recommended to aid pharyngeal clearing. Five of 17 (30%) patients required multiple FEES evaluations because of disease progression. For the first time in patients with ALS, FEES was shown to be successful in assessing preswallow anatomy and physiology, diagnosing pharyngeal dysphagia, and providing objective data for appropriate therapeutic interventions to promote safer oral intake. Visual biofeedback provided by FEES was successful for both patient and family education and to investigate individualized therapeutic strategies that, if successful, can be implemented immediately. Serial FEES allows for objective monitoring of dysphagia symptoms and timely implementation of diet changes and/or therapeutic strategies to continue safer oral intake and maintain optimum quality of life.
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References
EA Strand RM Miller KM Yorkston AD Hillel (1996) ArticleTitleManagement of oral–pharyngeal dysphagia symptoms in amyotrophic lateral sclerosis Dysphagia 11 129–139 Occurrence Handle1:STN:280:BymA3sbgt1M%3D Occurrence Handle8721072
BC Sonies (2000) ArticleTitlePatterns of care for dysphagic patients with degenerative neurological diseases Semin Speech Lang 21 333–345 Occurrence Handle10.1055/s-2000-8386 Occurrence Handle1:STN:280:DC%2BD3MzmvFKntA%3D%3D Occurrence Handle11085257
R Higo N Tayama T Watanabe T Nitou (2002) ArticleTitleVideomanofluorometric study in amyotrophic lateral sclerosis Laryngoscope 112 911–917 Occurrence Handle10.1097/00005537-200205000-00024 Occurrence Handle12150627
BR Brooks RG Miller M Swash TL Munsat (2000) ArticleTitleEl Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis Amyotroph Lateral Scler Other Motor Neuron Disord 1 293–299 Occurrence Handle10.1080/146608200300079536 Occurrence Handle1:STN:280:DC%2BD3Mvhs1Ghsg%3D%3D Occurrence Handle11464847
SB Leder CT Sasaki MI Burrell (1998) ArticleTitleFiberoptic endoscopic evaluation of dysphagia to identify silent aspiration Dysphagia 13 19–21 Occurrence Handle1:STN:280:DyaK1c%2FlsVWltA%3D%3D Occurrence Handle9391224
SE Langmore MA Schatz N Olsen (1988) ArticleTitleFiberoptic endoscopic examination of swallowing safety: a new procedure Dysphagia 2 216–219 Occurrence Handle1:STN:280:BiaB1cbhsVw%3D Occurrence Handle3251697
SE Langmore MA Schatz N Olsen (1991) ArticleTitleEndoscopic and videofluoroscopic evaluations of swallowing and aspiration Ann Otol Rhinol Laryngol 100 678–681 Occurrence Handle1:STN:280:By6A3snlvFY%3D Occurrence Handle1872520
TM Kidder SE Langmore BJW Martin (1994) ArticleTitleIndications and techniques of endoscopy in evaluation of cervical dysphagia: comparison with radiographic techniques Dysphagia 9 256–261 Occurrence Handle1:STN:280:ByqC3czpsVc%3D Occurrence Handle7805425
SB Leder (1998) ArticleTitleSerial fiberoptic endoscopic swallowing evaluations in the management of patients with dysphagia Arch Phys Med Rehabil 79 1264–1269 Occurrence Handle10.1016/S0003-9993(98)90273-8 Occurrence Handle1:STN:280:DyaK1cvltV2lsA%3D%3D Occurrence Handle9779682
P Linden AA Siebens (1983) ArticleTitleDysphagia: predicting laryngeal penetration Arch Phys Med Rehabil 64 281–284 Occurrence Handle1:STN:280:BiyB3s%2FhslY%3D Occurrence Handle6860100
J Murray SE Langmore S Ginsberg A Dostie (1996) ArticleTitleThe significance of oropharyngeal secretions and swallowing frequency in predicting aspiration Dysphagia 8 359–367
SB Leder DA Ross KB Briskin CT Sasaki (1997) ArticleTitleA prospective, double-blind, randomized study on the use of topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy J Speech Lang Hear Res 40 1352–1357 Occurrence Handle1:STN:280:DyaK1c%2Fpt1Gnug%3D%3D Occurrence Handle9430755
JA Logemann (1998) Evaluation and treatment of swallowing disorders, EditionNumber2nd ed Austin TX Pro-Ed
JR Duffy (1995) Motor speech disorders Mosby-Year Book St. Louis, MO
M Setzen MA Cohen PW Perlman PC Belafsky J Guss KF Mattucci M Ditkoff (2003) ArticleTitleThe association between laryngopharyngeal sensory deficits, pharyngeal motor function, and the prevalence of aspiration with thin liquids Otolaryngol Head Neck Surg 128 99–102 Occurrence Handle10.1067/mhn.2003.52 Occurrence Handle12574766
SB Leder DE Karas (2000) ArticleTitleFiberoptic endoscopic evaluation of swallowing in the pediatric population Laryngoscope 110 1132–1136 Occurrence Handle10.1097/00005537-200007000-00012 Occurrence Handle1:STN:280:DC%2BD3czkvVOksA%3D%3D Occurrence Handle10892683
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Leder, S.B., Novella, S. & Patwa, H. Use of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Amyotrophic Lateral Sclerosis. Dysphagia 19, 177–181 (2004). https://doi.org/10.1007/s00455-004-0009-2
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DOI: https://doi.org/10.1007/s00455-004-0009-2