Fiberoptic Endoscopic Evaluation of Swallowing vs Modified Barium Swallow

Educational Objectives

The goal of this program is to improve assessment of swallowing function. After hearing and assimilating this program, the clinician will be better able to:

1. Select a procedure for assessment of swallowing.

Summary

Swallowing evaluations: used to assess the physiology, safety, and effectiveness of swallowing, and the distinction between penetration and aspiration; swallowing evaluations may determine eligibility for swallowing therapy, the number of swallows necessary to clear residues, and the benefits of compensatory methods; evaluations may serve as records of the patient's swallowing status; assessments of swallowing ability may be used to identify the necessity for additional consultations

Fiberoptic endoscopic evaluation of swallowing (FEES): lip closure and oral residue may be visualized without the use of an endoscope; swallowing tests are used to evaluate 17 aspects of swallowing; FEES is used to measure duration of swallowing, initiation of the pharyngeal swallow, Wheeler elevation, pharyngeal residue, penetration, and aspiration; direct visualization of epiglottic inversion is possible with FEES in patients with reduced base of tongue retraction; laryngeal closure during swallowing may be assessed by FEES in cases of reduced base of tongue retraction, no epiglottic inversion, or supraglottic laryngectomy; modified barium swallow (MBS) is able to evaluate all of these factors

FEES vs MBS: FEES is an invasive procedure; FEES provides a clear assessment of pharyngeal anatomy and the pharyngeal phase of swallowing; additional oral components may be visualized; MBS is a fluoroscopic, noninvasive method which allows for analysis of the 17 components of the oropharyngeal swallow and assessment of the 3 phases of swallowing (ie, oral, pharyngeal, and esophageal); a moment of whiteout may occur during FEES as structures are compressing, eg, as the base of the tongue makes contact with the posterior pharyngeal wall; patients undergoing FEES are not exposed to radiation, but endoscope aversion may affect the results; assessment of secretion management is possible and evaluation of glottic closure is easier than with MBS

MBS: better tolerated than FEES (except in cases of barium aversion) and permits visualization of the entire swallowing process; may not be used to assess thick secretions that affect the flow of liquids or foods; the degree of base of tongue retraction reduction is clearly identified with MBS; swallowing exercises may be used to address mild reduction in retraction; MBS aids in guiding therapy based on deficits; laryngeal elevation may be seen with MBS but not FEES; biofeedback may be provided during therapy sessions with FEES; FEES is a more flexible tool for patients able to tolerate the endoscope; use of MBS may be limited due to radiation exposure

Readings

Brady S, Donzelli J. The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol Clin North Am. 2013;46(6):1009-1022. doi:10.1016/j.otc.2013.08.001; Hawkins D, Cabrera CI, Kominsky R, et al. Dysphagia evaluation: the added value of concurrent MBS and esophagram. Laryngoscope. 2021;131(12):2666-2670. doi:10.1002/lary.29377; Martin-Harris B, Canon CL, Bonilha HS, et al. Best practices in modified barium swallow studies. Am J Speech Lang Pathol. 2020;29(2S):1078-1093. doi:10.1044/2020_AJSLP-19-00189; Pisegna JM, Langmore SE. Parameters of instrumental swallowing evaluations: Describing a diagnostic dilemma. Dysphagia. 2016;31(3):462-472. doi:10.1007/s00455-016-9700-3; Schindler A, Baijens LWJ, Geneid A, et al. Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES. Eur Arch Otorhinolaryngol. 2022;279(6):2727-2742. doi:10.1007/s00405-021-07161-1; Vergara J, Miles A. Current evidence on pre-swallowing tasks during FEES: are they predictive of swallowing function?. Braz J Otorhinolaryngol. 2023;89(4):101280. doi:10.1016/j.bjorl.2023.101280.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Abrams was recorded online at Ninth Annual Atlantic Otolaryngology-Head and Neck Surgery Update, held February 25, 2023, and presented by The Johns Hopkins University School of Medicine. For information about upcoming CME activities from this presenter, please visit https://hopkinscme.cloud-cme.com. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.50 CE contact hours.

Lecture ID:

OT562201

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.