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Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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Abstract

The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is an instrumental assessment of deglutitive function that utilizes a flexible laryngoscope to view pharyngeal and laryngeal structures during swallowing. In this assessment the laryngoscope is placed transnasally and advanced to the pharynx to view structural movements, bolus transit and airway protection. The chapter elucidates the utility and practical application of laryngoscopy to assess swallowing function for the practicing clinician. The chapter includes a description of the procedure and guides the reader in the integration of visual findings that are revealed via the laryngoscope to better identify disordered physiology and further patient management.

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References

  1. Sawashima M, Hirose H. New laryngoscopic technique by use of fiber optics. J Acoust Soc Am. 1968;43:168–9.

    Article  PubMed  CAS  Google Scholar 

  2. Langmore S, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216–9.

    Article  PubMed  CAS  Google Scholar 

  3. Langmore S, Schatz K, Olsen N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100:678–81.

    PubMed  CAS  Google Scholar 

  4. Bastian R. Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol Head Neck Surg. 1991;104:339–50.

    PubMed  CAS  Google Scholar 

  5. FDA Public Health Advisory. FDA Public Health Advisory: Reports of Blue Discoloration and Death in Patients Receiving Enteral Feedings Tinted With The Dye, FD&C Blue No.1. 2003.

    Google Scholar 

  6. Leder S, Acton L, Lisitano H, Murray J. Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue dyed food. Dysphagia. 2005;20:157–62.

    Article  PubMed  Google Scholar 

  7. Nankivell P, Pothier D. Nasal and instrument preparation prior to rigid and flexible nasendoscopy: a systematic review. J Laryngol Otol. 2008;122:1024–8.

    Article  PubMed  CAS  Google Scholar 

  8. Frosh A, Jayaraj S, Porter G, Almeyda J. Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy? Clin Otolaryngol Allied Sci. 1998;23:259–62.

    Article  PubMed  CAS  Google Scholar 

  9. Pothier D, Raghava N, Monteiro P, Awad Z. A randomized controlled trial: is water better than a standard lubricant in nasendoscopy? Clin Otolaryngol Allied Sci. 2006;31:134–7.

    Article  CAS  Google Scholar 

  10. Rudnick E, Sie K. Velopharyngeal insufficiency: current concepts in diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2008;16:530–5.

    Article  PubMed  Google Scholar 

  11. Howell R, Davolos A, Clary M, Frake P, Joshi A, Chaboki H. Miller fisher syndrome presents as an acute voice change to hypernasal speech. Laryngoscope. 2010;120:978–80.

    Article  PubMed  Google Scholar 

  12. Stübgen J. Facioscapulohumeral muscular dystrophy: a radiologic and manometric study of the pharynx and esophagus. Dysphagia. 2008;23:341–7.

    Article  PubMed  Google Scholar 

  13. Warnecke T, Teismann I, Zimmermann J, Oelenberg S, Ringelstein E, Dziewas R. Fiberoptic endoscopic evaluation of swallowing with simultaneous tensilon application. J Neurol. 2008;255:224–30.

    Article  PubMed  Google Scholar 

  14. Tsuneo Y, Minoru S, Yoshihiro K, Takashi N, Ryuichi H, Satoshi E, et al. Functional outcomes and reevaluation of esophageal speech after free jejunal transfer in two hundred thirty-six cases. Ann Plast Surg. 2009;62:54–8.

    Article  Google Scholar 

  15. Franklin K, Anttila H, Axelsson S, et al. Effects and side-effects of surgery for snoring and obstructive sleep apnea: a systematic review. Sleep. 2009;32:27–36.

    PubMed  Google Scholar 

  16. Golding-Kushner K, Argamaso R, Cotton R, et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an International Working Group. Cleft Palate J. 1990;27:337–47.

    Article  PubMed  CAS  Google Scholar 

  17. Sie K, Starr J, Bloom D, Cunningham M, de Serres L, Drake A, et al. Multicenter interrater and intrarater reliability in the endoscopic evaluation of velopharyngeal insufficiency. Arch Otolaryngol Head Neck Surg. 2008;134:757–63.

    Article  PubMed  Google Scholar 

  18. Muntz H. Navigation of the nose with flexible fiberoptic endoscopy. Cleft Palate Craniofac J. 1992;29:507–10.

    Article  PubMed  CAS  Google Scholar 

  19. Hiss G, Postma N. Fiberoptic endoscopic evaluation of swallowing. Laryngoscope. 2003;113:1386–93.

    Article  PubMed  Google Scholar 

  20. Perlman A, Van Daele D. Simultaneous videoendoscopic and ultrasound measures of swallowing. J Med Speech Lang Pathol. 1993;1:223–32.

    Google Scholar 

  21. Postma G, McGuirt W, Butler S, Rees C, Crandall H, Tansavatdi K. Laryngopharyngeal abnormalities in hospitalized patients with dysphagia. Laryngoscope. 2007;117:1720–2.

    Article  PubMed  Google Scholar 

  22. Colton House J, Noordzij J, Burgia B, Langmore S. Laryngeal injury from prolonged intubation; a prospective analysis of contributing factors. Laryngoscope. 2011; 121:596–600.

    Article  PubMed  Google Scholar 

  23. Leder S, Suiter D. Effect of nasogastric tubes on incidence of aspiration. Arch Phys Med Rehabil. 2008;89:648–51.

    Article  PubMed  Google Scholar 

  24. Dziewas R, Warnecke T, Hamacher C, Oelenberg S, Teismann I, Kraemer C, et al. Do nasogastric tubes worsen dysphagia in patients with acute stroke? BMC. Neurology. 2008;8:29. http://www.biomedcentral.com/1471-2377/8/28.

    Google Scholar 

  25. Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia. 1996;11:99–103.

    Article  PubMed  CAS  Google Scholar 

  26. Donzelli J, Brady S, Wesling M, Craney M. Predictive value of accumulated oropharyngeal secretions for aspiration during video nasal endoscopic evaluation of the swallow. Ann Otol Rhinol Laryngol. 2003;112:469–75.

    PubMed  Google Scholar 

  27. Link D, Willging J, Miller C, Cotton R, Rudolph C. Pediatric laryngoscopic sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Ann Otol Rhinol Laryngol. 2000;109:899–905.

    PubMed  CAS  Google Scholar 

  28. Ota K, Saitoh E, Baba M, Sonoda S. The secretion severity rating scale: a potentially useful tool for management of acute-phase fasting stroke patients. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2009.11.015, doi:dx.doi.org

  29. Lear C, Flanagan J, Moorrees C. The frequency of deflutition in man. Arch Oral Biol. 1965;10:83–99.

    Article  PubMed  CAS  Google Scholar 

  30. Perie S, Laccourreye O, Bou-Malhab F, Brasnu D. Aspiration in unilateral recurrent laryngeal nerve paralysis after surgery. Am J Otolaryngol. 1998;19:18–23.

    Article  PubMed  CAS  Google Scholar 

  31. Bhattacharyya N, Kotz T, Shapiro J. Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Ann Otol Rhinol Laryngol. 2002;111:672–9.

    PubMed  Google Scholar 

  32. Nayak V, Bhattacharyya N, Kotz J, Shapiro J. Patterns of swallowing failure following medialization in unilateral vocal fold immobility. Laryngoscope. 2002;112:1840–4.

    Article  PubMed  Google Scholar 

  33. Amin M, Belafsky P. Cough and swallowing dysfunction. Otolaryngol Clin North Am. 2010;43:35–42.

    Article  PubMed  Google Scholar 

  34. Bastian R. The videoendoscopic swallowing study: an alternative and partner to the videofluoroscopic swallowing study. Dysphagia. 1993;8:359–67.

    Article  PubMed  CAS  Google Scholar 

  35. Leonard R, Belafsky P, Rees C. Relationship between fluoroscopic and manometric measures of pharyngeal constriction: the pharyngeal constriction ratio. Ann Otol Rhinol Laryngol. 2006;115:897–901.

    PubMed  Google Scholar 

  36. Fuller S, Leonard R, Aminpour S, Belafsky P. Validation of the pharyngeal squeeze maneuver. Otolaryngol Head Neck Surg. 2009;140:391–4.

    Article  PubMed  Google Scholar 

  37. Daniels S, Schroeder M, DeGeorge P, Corey D, Rosebek J. Effect of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol. 2007;16:140–7.

    Article  PubMed  Google Scholar 

  38. Martin-Harris B, Brodsky M, Michel Y, Lee F, Walters B. Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res. 2007;50:585–94.

    Article  PubMed  Google Scholar 

  39. Stephen J, Taves D, Martin R. Bolus location at the initiation of the pharyngeal stage of swallowing in healthy older adults. Dysphagia. 2005;20:266–72.

    Article  PubMed  Google Scholar 

  40. Wu H, Hsiao Y, Chen C, Chang C, Lee Y. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107:396–401.

    Article  PubMed  CAS  Google Scholar 

  41. Leder S, Sasaki C, Burrell M. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia. 1998;13:19–21.

    Article  PubMed  CAS  Google Scholar 

  42. Leder S, Karas D. Fiberoptic endoscopic evaluation of swallowing in the pediatric population. Laryngoscope. 2000;110:1132–6.

    Article  PubMed  CAS  Google Scholar 

  43. Kelly A, Drinnan M, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117:1723–7.

    Article  PubMed  Google Scholar 

  44. Gerek M, Atala A, Cekin F, 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;15:103–11.

    PubMed  Google Scholar 

  45. Tohara H, Nakane A, Murata S, Mikushi S, Ouchi Y, Wakasugi Y, et al. Inter- and intra-rater reliability in fibroptic endoscopic evaluation of swallowing. J Oral Rehabil. 2010;37:884–91.

    Article  PubMed  CAS  Google Scholar 

  46. Rosenbek J, Robbins J, Roecker E, Coyle J, Wood J. A penetration-aspiration scale. Dysphagia. 1996;11:93–8.

    Article  PubMed  CAS  Google Scholar 

  47. Molfenter S, Steele C. Physiological variability in the deglutition literature: hyoid and laryngeal kinematics. Dysphagia. 2010;26:67–74.

    Article  PubMed  Google Scholar 

  48. Van Daele D, Perlman A, Cassell M. Intrinsic fibre architecture and attachments of the human epiglottis and their contributions to the mechanism of deglutition. J Anat. 1995;186:1–15.

    Google Scholar 

  49. Veis S, Logemann J, Colangelo L. Effects of three techniques on maximum posterior movement of tongue base. Dysphagia. 2000;15:142–5.

    PubMed  CAS  Google Scholar 

  50. Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in post deglutition retention in the elderly. Dysphagia. 1997;12:63–7.

    Article  PubMed  CAS  Google Scholar 

  51. Pauloski B, Rademaker A, Lazarus C, Boeckxstaens G, Kahrilas P, Logemann J. Relationship between manometric and videofluoroscopic measures of swallow function in healthy adults and patients treated for head and neck cancer with various modalities. Dysphagia. 2009;24:196–203.

    Article  PubMed  Google Scholar 

  52. Hey C, Pluschinski P, Stanschus S, Euler HA, Sader RA, Langmore S, et al. A documentation system to save time and ensure proper application of the fiberoptic endoscopic evaluation of swallowing (FEES®). Folia Phoniatr Logop. 2011;63:201–8.

    Article  PubMed  Google Scholar 

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Correspondence to Joseph Murray PhD .

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Langmore, S.E., Murray, J. (2013). Fiberoptic Endoscopic Evaluation of Swallowing (FEES). In: Shaker, R., Easterling, C., Belafsky, P., Postma, G. (eds) Manual of Diagnostic and Therapeutic Techniques for Disorders of Deglutition. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3779-6_5

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  • DOI: https://doi.org/10.1007/978-1-4614-3779-6_5

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-3778-9

  • Online ISBN: 978-1-4614-3779-6

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