Simultaneous Modified Evans Blue Dye Procedure and Video Nasal Endoscopic Evaluation of the Swallow

Donzelli, Joseph; Brady, Susan; Wesling, Michele; Craney, Mary

doi:10.1097/00005537-200110000-00015

Cited by 67 publications

(33 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After the initial bolus presentations with the tracheotomy tube in place, the tracheotomy tube was removed and subglottal viewing through the tracheostoma was completed (Fig. 2) as previously described [13]. Briefly, the endoscope was inserted into the stoma site and was flexed upward to obtain a view of the subglottal structures and then turned downward to view the bronchial tree in order to confirm tracheal aspiration.…”

Section: Subjectsmentioning

confidence: 99%

Effects of the Removal of the Tracheotomy Tube on Swallowing During the Fiberoptic Endoscopic Exam of the Swallow (FEES)

et al. 2005

Self Cite

View full text Add to dashboard Cite

This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.

show abstract

Section: Subjectsmentioning

confidence: 99%

Effects of the Removal of the Tracheotomy Tube on Swallowing During the Fiberoptic Endoscopic Exam of the Swallow (FEES)

et al. 2005

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several authors [76][77][78][79][80] have compared the accuracy of dye studies with those of VSS and FEES. Three studies [76][77][78] have reported a false negative rate of 50-61% but specificities near 100%. In these studies, foods of various consistencies for VSS or FEES were dyed blue and the tracheostomy tube was then suctioned.…”

Section: Dye Studiesmentioning

confidence: 99%

Advances in the diagnosis and management of chronic pulmonary aspiration in children

et al. 2006

View full text Add to dashboard Cite

Chronic pulmonary aspiration (CPA) in children is an important cause of recurrent pneumonia, progressive lung injury, respiratory disability and death. It is sporadic, intermittent and variable, and often occurs in children with complicated underlying medical conditions and syndromes that produce symptoms indistinguishable from CPA. For most types of aspiration there is no gold-standard diagnostic test. The diagnosis of CPA is currently made clinically with some supporting diagnostic evaluations, but often not until significant lung injury has been sustained. Despite multiple diagnostic techniques, the diagnosis or exclusion of CPA in children is challenging. This is of particular concern given the outcome of unrecognised progressive lung injury and the invasiveness of definitive therapies.Although new techniques have been introduced since the 1990s and significant advances in the understanding of dysphagia and gastro-oesophageal reflux have been made, characterisation of the aspirating child remains elusive.

show abstract

“…Since blue is not a color found in oropharyngeal secretions, blue dye has been used to detect aspiration without feeding trials [2], as well as added to enteral feedings of critically ill patients [3,4] and to oral feedings of patients with suspected dysphagia [5,6], for over 25 years. New concerns, however, have developed over both the safety [1,[7][8][9] and sensitivity [10][11][12] of blue dye use.…”

mentioning

confidence: 99%

“…Objective analyses, however, found that the blue dye method had poor sensitivity, i.e., a high false positive rate, for detecting aspiration in both enterally fed patients [3,20,21] and during dysphagia evaluations [10][11][12]. Although the FDA recommended 12 mg/kg/day as the limit for oral FD&C Blue No.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with and without Blue-Dyed Food

et al. 2005

View full text Add to dashboard Cite

The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech-language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61-1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.

show abstract

Simultaneous Modified Evans Blue Dye Procedure and Video Nasal Endoscopic Evaluation of the Swallow

Abstract: The results of the current investigation suggest that the MEBD, at best, should be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.

Cited by 67 publications

References 27 publications

Effects of the Removal of the Tracheotomy Tube on Swallowing During the Fiberoptic Endoscopic Exam of the Swallow (FEES)

Effects of the Removal of the Tracheotomy Tube on Swallowing During the Fiberoptic Endoscopic Exam of the Swallow (FEES)

Advances in the diagnosis and management of chronic pulmonary aspiration in children

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with and without Blue-Dyed Food

Contact Info

Product

Resources

About