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A commentary on FEES research (Pisegna, 2022)

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posted on 08.11.2022, 22:37 authored by Jessica M. Pisegna

Purpose: Fiberoptic endoscopic evaluation of swallowing (FEES) is a well-respected swallowing assessment, harking back to 1988 when it was first published by Susan Langmore as a procedure. Since then, its methodology has evolved to afford clinicians, researchers, and patients a sensitive, specific, and predictive exam. A myriad research has investigated FEES technique and its outcomes, rendering it an effective and efficient procedure for swallowing assessment and therapy. This commentary will outline evidence for FEES to support evidence-based practice. What is the evidence for speech tasks? Secretion scales? What is the predictive nature of aspiration as seen on FEES? This comprehensive review will outline the science bolstering the use and confidence in FEES.

Conclusions: This commentary reviews studies that have proposed normative data collected via FEES for decision making, specifically when assessing pharyngeal and laryngeal anatomy, bolus spillage, and the white out period. Evidence for FEES sensitivity and predictive aspects are reviewed in relationship to speech tasks, secretions, aspiration and penetration–aspiration scale scores, and pharyngeal residue scales. The acute care advantage of FEES is defined in its use on postextubation populations, assessment of dysphagia in COVID-19 positive patients, and safe evaluation during ice chip administration with acutely ill patients. Finally, inference making on FEES is discussed in regard to epiglottic retroflexion and depth of aspiration.

When it comes to assessing pharyngeal dysphagia, the true strengths of FEES are rooted in evidence. It has been shown to be sensitive, predictive, and practical and will likely continue to have stronger support as research continues to enrich its potential.

Supplemental Video S1. An example of two boluses trials from an FEES on a postextubated patient who demonstrates laryngeal pathology and dysphagia.

Supplemental Video S2. An example of two of the three ice chips during an Ice Chip Protocol for an acutely ill patient with a nasogastric tube in place. 

Pisegna, J. M. (2022). What’s the evidence? A commentary on FEES research. Perspectives of the ASHA Special Interest Groups. Advance online publication. https://doi.org/10.1044/2022_PERSP-22-00128

Publisher Note: This article is part of the Forum: Flexible Endoscopic Evaluation of Swallowing (FEES): Practical Considerations for Performance and Interpretation.


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