Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) in Healthy Controls

Abstract

The purpose of this study was to introduce a new method of bedside assessment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). This approach combines the established bedside endoscopic swallowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discrimination thresholds by delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a flexible endoscope. A prospective study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (< 4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (> 6.0 mmHg APP). Subsequent to LP sensory testing, food of varying consistencies, mixed with green food coloring, was given and attention was paid to spillage, laryngeal penetration, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were performed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). There were no instances of spillage, laryngeal penetration, or aspiration. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. Institution of therapeutic maneuvers resulted in a predictable change in the endoscopic view of the laryngopharyngeal anatomy. FEESST provides comprehensive, objective sensory and motor information about deglutition in the bedside setting and might have implications for the bedside diagnosis and management of patients with dysphagia.

Patient assessed symptoms are poor predictors of objective findings. Results from a cross sectional study in patients treated with radiotherapy for pharyngeal cancer

“…The swallowing function of the patients was examined using Functional Endoscopic Evaluation of swallowing (FEES), a standardized test using predefined endpoints [20]. This examination was chosen since it provided information on the sensitivity of the throat Á a common problem after radiotherapy [13].…”

Normal Swallowing Physiology as Viewed by Videofluoroscopy and Videoendoscopy

“…Clinical application of this procedure has also been limited for this reason. In the past 5-10 years, videonasendoscopy has been used to examine the oropharynx before and during deglutition [7,11,12,19,20]. The endoscopic procedure has been labeled fiberoptic endoscopic examination of swallowing (FEES) by some clinicians and is in use in some facilities as the instrumental swallow assessment, particularly when videofluoroscopy is not available or difficult to obtain.…”

“…The endoscopic procedure has been labeled fiberoptic endoscopic examination of swallowing (FEES) by some clinicians and is in use in some facilities as the instrumental swallow assessment, particularly when videofluoroscopy is not available or difficult to obtain. If sensory testing is incorporated with the endoscopic examination the procedure is know as fiberoptic endoscopic examination of swallowing and sensory testing (FEESST) [20].…”

Food Measures and Other Critical Diagnostic Measures

“…In order to accomplish this goal, newer, practical and/or more sophisticated investigative techniques continue to be developed and implemented [19][20][21][22][23][24][25][26][27][28][29]. Today, due to increasing attention to the efficacy studies in our field [30][31][32][33][34][35][36], the importance of quantifying the data of normal and abnormal swallowing are addressed more than before for comparative purposes [20,22,[26][27][28]. Most importantly, such quantification requires meaningful objective measures.…”