Endoscopy Assesment of Swallowing

FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING (FEES)
IN PATIENTS WITH OROPHARYNGEAL DYSPHAGIA
 
Eleftherakis Athanasios
ENT doctor
Head und cervix surgeon
 
Swallowing disorders can occur as a consequence of diseases in people of every walk of life, from neonates to elderly patients. 
Causes:
  • Congenital diseases
  • Inflammations
  • Benign and malignant tumors
  • Head and cervix radiotherapy
  • Nervous system diseases
  1. Vascular-cerebral incident
  2. Cerebral injuries
  3. Cerebral palsy
  4. Parkinson-disease
  5. Multiple sclerosis 
  • Neuromuscular diseases
  1. Polymyositis (PM)
  2. Gravis-myasthenia
  3. Muscular dystrophy
  4. Amyotrophic Lateral Sclerosis (ALS)
  • Operations (otolaryngology, neurosurgery, thoracic surgery) 
  • Injuries 
 
According to each case, patients can show:
  • Precise sense of swallowing disorders (they can describe them) or
  • Non-consciousness and ignorance of these disorders (patients with silent aspiration or conscience-awareness deficit)
The therapeutic treatment is complex and aims at:
  • Treatment of the disorder that caused dysphagia 
  • Therapeutic intervention for the treatment of dysphagia 
The Fiberoptic Endoscopic Evaluation of Swallowing includes:
  • The endoscopic check of the structures and functions of the upper respiratory tract and digestive system
  • The endoscopy during the swallowing of colored food with different composition (liquids, crèmes and solids)
  • The implementation of swallowing operations (the therapeutic effectiveness of the operations and the execution potentiality of the patient can be immediately evaluated) 
 
The equipment needed is the slim, flexible laryngoscope and a portable source of LED light. The laryngoscope can be optionally connected to a recording system and a screen. (Picture 2).
 
It is important to point out that the treatment of the swallowing disorders is a subject of group intervention. This group consists of (Pictures 1-9):
  • The attending doctor that treats the disease 
  • The ENT doctor
  • The physiatrist
  • The speech therapist 
  • Doctors and other health professionals in rehabilitation centers (psychiatrist, dietician, nurses, physiotherapist)
  • The relatives
  • THE PATIENT 
The therapeutic strategy also includes interventions:
  • Personalized
  • Modified (as the swallowing capability of the patient evolves)

 

Advantages and disadvantages of the Fiberoptic Endoscopic Evaluation of Swallowing:
  • Advantages:
  1. No complex or expensive equipment needed
  2. No radiation
  3. Can be repeated easily and as often as needed
  4. No moving of the patient needed (can be conducted while the patient is in his bed, in an intensive care unit, in rehabilitation centers, at home)
  5. Better anatomical and neurological evaluation in contrast to other methods (Videofluoroscopic swallowing study)  
  6. The results of the therapeutic operations can be checked immediately
  7. Has a relatively low cost
  • Disadvantages:
  1. The pharyngeal phase cannot be fully checked (instant vision gap) as the soft palate, the base of the tongue and the pharynx walls converge. The total swallowing capability and the security grade (vital importance) can be checked. 
  2. The esophageal phase cannot be checked
  3. It is not taught to ENT doctors and speech therapists
  4. The patient might not tolerate it (extremely rare)
  5. Complications such as nose bleed, laryngospasm, regurgitation (also extremely rare when conducted by specialized and experienced doctors)
 
Рисунок 1. Состав пережеванной пищи
Рисунок 2. Оборудование для эндоскопического исследования глотания
Рисунки 1-9. Группа при проведении обследования