Narrow band imaging in flexible endoscopic evaluation of swallowing (Niessen et al., 2023)
Purpose: The purposes of this study were to compare the visibility of various color groups in different dilutions using narrow band imaging (NBI) and white light (WL) and to determine an optimal color combination using NBI and WL for multicolor flexible endoscopic evaluation of swallowing (FEES), for example, to test different consistencies.
Method: Preliminary examinations were performed in the oral cavity of two healthy volunteers. Various dyes were tested using NBI and WL to evaluate their visibilities. In the case of a clearly discernible color change, the visibility differences in the dilution series under WL and NBI were recorded and compared. Subsequently, an abbreviated dilution series with NBI and WL was performed in a volunteer as part of a swallow endoscopy to determine whether the results from the oral cavity could be transferred to the hypopharynx.
Results: The enhancement of visibility using NBI compared with WL can be proven. When NBI was used, yellow and red food dyes and their mixtures showed distinct color changes. The reacting dyes were still visible under NBI, even at a 10-times-higher dilution, requiring a lower dye concentration for FEES. For increased visibility, the dyes used for FEES with NBI must contain colors from a small range in the yellow and red spectra, which are close to the filter maxima of NBI. Both colors are well visible under WL when combining red and green (secondary color of yellow).
Conclusions: Certain food colorings are visible 10 times more diluted under NBI than under WL. In a multicolored approach, optimal visibility under NBI and WL can be achieved by combining green and red. This new high-sensitivity FEES should be highlighted to allow an instant distinction from WL-FEES; we suggest “FEES+.”
Supplemental Material S1. Penetration becomes visible when starting NBI (green food dye).
Supplemental Material S2. Although the red is not as close to the appropriate peak as the green, the bubble in the laryngeal aperture on the right side only turns out to contain color when NBI is turned on.
Supplemental Material S3. In the starting sequence, green residues are seen, and no penetration. When switching to NBI, the penetration in the anterior commissure and even a micro-aspiration becomes apparent.
Niessen, A., Nienstedt, J. C., Flügel, T., Koseki, J.-C., Müller, F., Zang, J., & Pflug, C. (2023). Narrow band imaging in flexible endoscopic evaluation of swallowing—How does it work? Journal of Speech, Language, and Hearing Research, 66(6), 2035–2046. https://doi.org/10.1044/2023_JSLHR-22-00579