Endoscopic and Videofluoroscopic Evaluations of Swallowing and Aspiration

TLDR

Certain patient populations and conditions are identified as suitable for this procedure. The study compares a fiberoptic laryngoscopy–based evaluation of oropharyngeal dysphagia to videofluoroscopy. Twenty‑one subjects underwent both FEES and videofluoroscopy within 48 hours, and the two modalities were compared for abnormal events and diagnostic accuracy metrics. FEES showed high agreement with videofluoroscopy, particularly for aspiration (90 % agreement), with sensitivities ≥0.88 for most metrics and a specificity of 0.92 for aspiration, supporting its validity as a dysphagia evaluation tool.

Abstract

A new procedure for evaluating oropharyngeal dysphagia utilizing fiberoptic laryngoscopy was compared to the videofluoroscopy procedure. Twenty-one subjects were given both examinations within a 48-hour period. Results of the fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy examinations were compared for presence or absence of abnormal events. Good agreement was found, especially for the finding of aspiration (90% agreement). The FEES was then measured against the videofluoroscopy study for sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity was 0.88 or greater for three of the four parameters measured. Specificity was lower overall, but was still 0.92 for detection of aspiration. It was concluded that the FEES is a valid and valuable tool for evaluating oropharyngeal dysphagia. Some specific patients and conditions that lend themselves to this procedure are discussed.