Role of Fibreoptic Endoscopic Evaluation of Swallowing (FEES) in the management of Oropharyngeal Dysphagia
Keywords:
Orophayngeal dysphagia (OD), Fibreoptic Endoscopic Evaluation of Swallowing (FEES),PAS score, Silent Aspiration, Food consistencyAbstract
BACKGROUND- Fibreoptic endoscopic evaluation of swallowing (FEES) is one of the tools for the assessment of oropharyngeal dysphagia (OD). The objectives of our study were to evaluate the role of FEES in deciding the management of OD in our indoor and outdoor patients and study the recovery pattern.
METHODS- A total of 30 consecutive patients of OD on whom FEES was performed to formulate management strategy were included in our study. The detailed history, levels of dysphagia, laryngeal sensations, penetration, aspiration, hyolaryngeal elevation and response to dry swallow as well as various food consistensies was noted in every serial FEES test. Silent aspiration of saliva and/or food was specifically looked for.The management strategies planned as a result of the FEES findings with subsequent response to them were noted. The Penetration-Aspiration Score (PAS) was utilised to monitor progress of the OD.
RESULT- In 30 patients of OD, 9 patients belonged to neurosurgery group, 5 neurodegenerative group, 12 stroke patients, 2 head and neck cancer surgery, and 2 had an idiopathic aetiology. Aspiration of saliva was detected in 19/30 (63.3%) patients with 10/30 (33.3%) having silent aspiration pre-therapy.
Aspiration of saliva was detected in 6(20%) patients post therapy using FEES guidance.Out of these 6 patients 5 patients had a silent aspiration of the saliva. Two stroke patients, one patient of head neck cancer surgery, one post neurosurgery and two patients of neurodegenerative group (because of primary disease progression) did not show any improvement. Pre therapy 25 patients had aspiration with food, post therapy 6 patients had aspiration with both food and saliva.
Average time for improvement in neurosurgery patients was 2.8 months, in neurodegenerative patients 2 months, in stroke 3 months, in head neck surgery patients 5.5 months and in idiopathic aetiology patients it was 1 month. A minimum of 1 month and a maximum of 1 year was the range for follow up.
The PAS score comparison revealed that neurological patients showed a higher PAS score (worse response) with thin and mild thick, whereas head neck cancer patients had a higher PAS score (worse response) with extremely thick consistency.
CONCLUSION - Utilizing fees in 30 cases of OD we detected aspiration of saliva in 63% and aspiration of food on 83.33%; 33% of these patients had silent aspiration. Post therapy aspiration of saliva and food reduced to 20%, out of which 16.66 % were silent aspirators. FEES can effectively and objectively identify the silent aspirators who seemed to have the worst prognosis in our study group.
KEYWORDS- Orophayngeal dysphagia (OD), Fibreoptic Endoscopic Evaluation of Swallowing (FEES),PAS score, Silent Aspiration, Food consistency
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