FEESST: A New Bedside Endoscopic Test of the Motor and Sensory Components of Swallowing

1998 ◽  
Vol 107 (5) ◽  
pp. 378-387 ◽  
Author(s):  
Ted Kim ◽  
Kathy Goodhart ◽  
Jonathan E. Aviv ◽  
Ralph L. Sacco ◽  
Beverly Diamond ◽  
...  
Keyword(s):  
Superior Laryngeal Nerve ◽  
Oral Feeding ◽  
Sensory Testing ◽  
Endoscopic Evaluation ◽  
Sensory Deficits ◽  
Laryngeal Penetration ◽  
Sensory Capacity ◽  
Bedside Method ◽  
Normal Sensitivity ◽  
Endoscopic Assessment

We here introduce an office or bedside method of evaluating both the motor and sensory components of swallowing, called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal (LP) sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of LP sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 148 times on 133 patients with dysphagia over an 8-month period. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 94). Subsequent to LP sensory testing, a complete dysphagia evaluation was conducted. Various food and liquid consistencies were dyed green, and attention was paid to their management throughout the pharyngeal stage of swallowing. Evidence of latent swallow initiation, pharyngeal pooling and/or residue, laryngeal penetration, laryngeal aspiration, and/or reflux was noted. Recommendations for therapeutic intervention were based on information obtained during the FEESST and often involved the employment of compensatory swallowing strategies, modification of the diet or its presentation, placement on non-oral feeding status, and/or referral to other related specialists. All patients successfully completed the examination. In 111 of the evaluations (75%), severe (>6.0 mm Hg air pulse pressure [APP]) unilateral or bilateral LP sensory deficits were found. With puree consistencies, 31% of evaluations with severe deficits, compared to 5% of evaluations with either normal sensitivity or moderate (4.0 to 6.0 mm Hg APP) LP sensory deficits, displayed aspiration (p <.001, χ2 test). With puree consistencies, 69% of evaluations with severe deficits, compared to 24% with normal or moderate deficits, displayed laryngeal penetration (p <.001, χ2 test). FEESST allows the clinician to obtain a comprehensive bedside assessment of swallowing that is performed as the initial swallowing evaluation for the patient with dysphagia.

scholarly journals Predicting feeding-tube dependence in patients following endotracheal extubation: a two-item swallowing screen

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shu-Fen Siao ◽  
Wen-Hsuan Tseng ◽  
Tyng-Guey Wang ◽  
Yu-Chung Wei ◽  
Tzu-Yu Hsiao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Feeding Tube ◽  
Oral Feeding ◽  
Invasive Ventilation ◽  
Endoscopic Evaluation ◽  
Icu Patients ◽  
Cough Reflex ◽  
Risk Patients ◽  
To Receive ◽  
Endotracheal Extubation

Abstract Background To meet the surging demands for intubation and invasive ventilation as more COVID-19 patients begin their recovery, clinicians are challenged to find an ultra-brief and minimally invasive screen for postextubation dysphagia predicting feeding-tube dependence persisting for 72 h after extubation. Methods This study examined the predictive validity of a two-item swallowing screen on feeding-tube dependence over 72 h in patients following endotracheal extubation. Intensive-care-unit (ICU) patients (≥ 20 years) successfully extubated after ≥ 48 h endotracheal intubation were screened by trained nurses using the swallowing screen (comprising oral stereognosis and cough-reflex tests) 24 h postextubation. Feeding-tube dependence persisting for 72 h postextubation was abstracted from the medical record by an independent rater. To verify the results and cross-check whether the screen predicted penetration and/or aspiration during fiberoptic endoscopic evaluation of swallowing (FEES), participants agreeing to receive FEES were analyzed within 30 min of screening. Results The results showed that 95/123 participants (77.2%) failed the screen, which predicted ICU patients’ prolonged (> 72 h) feeding-tube dependence, yielding sensitivity of 0.83, specificity of 0.35, and accuracy of 0.68. Failed-screen participants had 2.96-fold higher odds of feeding-tube dependence (95% CI, 1.13–7.76). For the 38 participants receiving FEES, the swallowing screen had 0.89 sensitivity to detect feeding-tube dependence and 0.86 sensitivity to predict penetration/aspiration, although specificity had room for improvement (0.36 and 0.21, respectively). Conclusion This ultra-brief swallowing screen is sufficiently sensitive to identify high-risk patients for feeding-tube dependence persisting over 72 h after extubation. Once identified, a further assessment and care are indicated to ensure the prompt return of patients’ oral feeding. Trial registration NCT03284892, registered on September 15, 2017.

scholarly journals Transnasal Endoscopic Evaluation of Swallowing: A Bedside Technique to Evaluate Ability to Swallow Pureed Diets in Elderly Patients with Dysphagia

2013 ◽  
Vol 27 (8) ◽  
pp. 459-462 ◽  
Author(s):  
Torao Sakamoto ◽  
Akira Horiuchi ◽  
Yoshiko Nakayama
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Elderly Patients ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Endoscopic Evaluation ◽  
Transnasal Endoscopy ◽  
Comorbid Diseases ◽  
Bedside Method

BACKGROUND: Endoscopic evaluation of swallowing (EES) is not commonly used by gastroenterologists to evaluate swallowing in patients with dysphagia.OBJECTIVE: To use transnasal endoscopy to identify factors predicting successful or failed swallowing of pureed foods in elderly patients with dysphagia.METHODS: EES of pureed foods was performed by a gastroenterologist using a small-calibre transnasal endoscope. Factors related to successful versus unsuccessful swallowing of pureed foods were analyzed with regard to age, comorbid diseases, swallowing activity, saliva pooling, vallecular residues, pharyngeal residues and airway penetration/aspiration. Unsuccessful swallowing was defined in patients who could not eat pureed foods at bedside during hospitalization. Logistic regression analysis was used to identify independent predictors of swallowing of pureed foods.RESULTS: During a six-year period, 458 consecutive patients (mean age 80 years [range 39 to 97 years]) were considered for the study, including 285 (62%) men. Saliva pooling, vallecular residues, pharyngeal residues and penetration/aspiration were found in 240 (52%), 73 (16%), 226 (49%) and 232 patients (51%), respectively. Overall, 247 patients (54%) failed to swallow pureed foods. Multivariate logistic regression analysis demonstrated that the presence of pharyngeal residues (OR 6.0) and saliva pooling (OR 4.6) occurred significantly more frequently in patients who failed to swallow pureed foods.CONCLUSIONS: Pharyngeal residues and saliva pooling predicted impaired swallowing of pureed foods. Transnasal EES performed by a gastroenterologist provided a unique bedside method of assessing the ability to swallow pureed foods in elderly patients with dysphagia.

Flexible Endoscopic Evaluation of Swallowing with Sensory Testing: Patient Characteristics and Analysis of Safety in 1,340 Consecutive Examinations

2005 ◽  
Vol 114 (3) ◽  
pp. 173-176 ◽  
Author(s):  
Jonathan E. Aviv ◽  
Thomas Murry ◽  
Manderly Cohen ◽  
Anne Zschommler ◽  
Carolyn Gartner
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Patient Characteristics ◽  
Acid Reflux ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Safe Procedure ◽  
Airway Compromise ◽  
Sensory Testing ◽  
Endoscopic Evaluation

Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) is a comprehensive endoscopic assessment of the sensory and motor components of a swallow. Previous studies addressing patient safety issues with respect to FEESST included relatively small numbers of patients and paid almost no attention to patient characteristics. The purpose of this study was to determine the incidence of FEESST-related complications in the outpatient and inpatient settings and to analyze patient diagnoses that led to the performance of FEESST. We performed a prospective study of FEESST complications in 1,340 consecutive evaluations performed over a 4 1/2-year period. The primary outcome variables were incidence of epistaxis and airway compromise. The secondary outcome variable was underlying patient diagnoses. The incidence of epistaxis was 1 in 1,340 (0.07%). There were no instances of airway compromise. Stroke was the most common reason for the performance of FEESST (343; 25.6%), followed by cardiac-related dysphagia (298; 22.2%) following open heart surgery (169/298; 56.7%), heart attack, congestive heart failure, or new arrhythmia. The remaining causes were head and neck cancer (207; 15.4%), pulmonary disease (141; 10.5%), chronic neurologic disease (124; 9.3%), and acid reflux disease (80; 6.0%). We conclude that FEESST is a relatively safe procedure for the sensory and motor assessment of dysphagia in a cohort of patients with a wide variety of underlying diagnoses. The emergence of cardiac surgery as a common cause of dysphagia warrants further study.

scholarly journals Assessment of swallowing in preterm newborns fed by bottle and cup

CoDAS ◽  
2014 ◽  
Vol 26 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Claudia Peyres López ◽  
Brasília Maria Chiari ◽  
Ana Lúcia Goulart ◽  
Ana Maria Furkim ◽  
Zelita Caldeira Ferreira Guedes
Keyword(s):  
Oral Feeding ◽  
Minimal Amount ◽  
Genetic Syndromes ◽  
Average Birth Weight ◽  
Low Weight ◽  
Study Results ◽  
Laryngeal Penetration ◽  
Neurological Illnesses ◽  
Preterm Newborns ◽  
Tracheal Aspiration

Purpose: To compare the swallowing performance of premature infants using a cup and a bottle during the first offer of food by mouth. Methods: This study was carried out with preterm newborns who presented low weight at birth and no neurological illnesses, genetic syndromes or congenital malformations. The newborns were assessed by videofluoroscopy while using a cup and a bottle, when they reached a post-conceptual age of ≥34 weeks, weight ≥ 1,500 g and showed signs of readiness for oral feeding. All children were fed exclusively by gavage during the period prior to the study. Results: This study included 20 preterm newborns, with average birth weight of 1,356 g and gestational age of 31.3 weeks. The majority of the bottle-fed newborns (68%) presented strong and rhythmic suction and 63% showed good sucking/swallowing/breathing coordination. The same percentage of newborns fed by cup (68%) could not perform the sipping movement and only 32% could suck a minimal amount of liquid contrast. There were no signs of laryngeal penetration and tracheal aspiration in both procedures. Conclusion: At the first oral feeding, preterm newborns showed better swallowing performance with a bottle in comparison to using a cup.

Laryngeal sensory testing in the assessment of patients with laryngopharyngeal reflux

2009 ◽  
Vol 124 (3) ◽  
pp. 330-332 ◽  
Author(s):  
O T Dale ◽  
O Alhamarneh ◽  
K Young ◽  
S Mohan
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Response To Treatment ◽  
Sensory Impairment ◽  
Sensory Testing ◽  
Laryngeal Mucosa ◽  
Sensory Capacity ◽  
Laryngeal Adductor Reflex

AbstractLaryngopharyngeal reflux is commonly encountered in the ENT out-patient setting. It leads to impaired sensory capacity of the laryngeal mucosa. The sensory integrity of the laryngopharynx can be evaluated through endoscopic administration of pulsed air, which stimulates the laryngeal adductor reflex. The pressure of air needed to elicit this reflex indicates the degree of sensory impairment. Such laryngeal sensory testing gives a quantifiable means of assessment in patients with laryngopharyngeal reflux, and can be used to measure the response to treatment. Laryngeal sensory testing is safe and well tolerated by patients.

scholarly journals Effects of nasal continuous positive-airway pressure on nutritive swallowing in lambs

2012 ◽  
Vol 112 (12) ◽  
pp. 1984-1991 ◽  
Author(s):  
Anne Bernier ◽  
Céline Catelin ◽  
Mohamed Amine Hadj Ahmed ◽  
Nathalie Samson ◽  
Pauline Bonneau ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Current Knowledge ◽  
Ventilatory Support ◽  
Bottle Feeding ◽  
Oral Feeding ◽  
Great Success ◽  
Arterial Blood ◽  
Laryngeal Penetration

Current knowledge suggests that, to be successful, oral feeding in preterm infants should be initiated as soon as possible, often at an age where immature respiration still requires ventilatory support in the form of nasal continuous positive airway pressure (nCPAP). While some neonatologist teams claim great success with initiation of oral feeding in immature infants with nCPAP, others strictly wait for this ventilatory support to be no longer necessary before any attempt at oral feeding, fearing laryngeal penetration and tracheal aspiration. Therefore, the aim of the present study was to provide a first assessment of the effect of various levels of nCPAP on bottle-feeding in a neonatal ovine model, including feeding safety, feeding efficiency, and nutritive swallowing-breathing coordination. Eight lambs born at term were surgically instrumented 48 h after birth to collect recordings of electrical activity of laryngeal constrictor muscle, electrocardiography, and arterial blood gases. Two days after surgery, lambs were bottle-fed under five randomized nCPAP conditions, including without any nCPAP or nasal mask and nCPAP of 0, 4, 7, and 10 cmH2O. Results revealed that application of nCPAP in the full-term lamb had no deleterious effect on feeding safety and efficiency or on nutritive swallowing-breathing coordination. The present study provides a first and unique insight on the effect of nCPAP on oral feeding, demonstrating its safety in newborn lambs born at term. These results open the way for further research in preterm lambs to better mimic the problems encountered in neonatology.

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