The Diagnostic Usefulness of the Fiberoptic Endoscopic Evaluation of Swallowing

ABSTRACT

OBJECTIVE: To investigate if adding fiberoptic endoscopic evaluation of swallowing (FEES) to the videofluoroscopic swallowing study (VFSS) will improve the detection of abnormalities related to swallowing and pharyngolaryngeal structures. METHOD: Sixty-nine subjects (47 men, aged 64.8+/-12.0 years) with dysphagia were evaluated using VFSS and FEES simultaneously. VFSS and FEES were independently interpreted by two different examiners, who were blinded to the results of the other study. The foods that were examined were a 5-ml semi-blended diet (SBD), plain yogurt, boiled rice (NRD), and 2-ml (small fluid, SF) and 5-ml (large fluid, LF) diluted liquid barium. The detection rates of penetration or aspiration and of the pharyngeal residues in VFSS and FEES were compared. RESULTS: Combining FEES with VFSS raised the detection rates of penetration (p=0.008 for SF and LF; p<0.001 for SBD, yogurt, and NRD) and of the pharyngeal residues (p<0.001 for SF, SBD, yogurt, and NRD; p=0.001 and 0.002 for LF in the vallecula and pyriform sinus, respectively) in all the food types. Adding FEES also improved the detection of fluid aspiration (p=0.03 and 0.02 for SF and LF, respectively). Oral and pharyngeal lesions such as candidiasis, and other mucosal abnormalities, were also detected by FEES. CONCLUSION: Combining FEES with VFSS raised the diagnostic sensitivities of penetration, aspiration, and pharyngeal residues compared to the evaluation using VFSS alone. It also enabled the visualization of the abnormal structural changes in the pharyngolarynx. FEES can be performed safely by physiatrists.