Until 1980, the primary technique for assessing patients with dysphagia was the modified barium swallow (MBS). It was then that fiberoptic endoscopic evaluation of swallowing was added to the diagnostic armamentarium. In the 1990s, flexible endoscopic evaluation of swallowing with sensory testing (FEESST) added additional options, offering superior technology to assess both bolus transport and airway protection without the radiation exposure that accompanies the MBS. Jonathan E. Aviv, MD, Professor of Otolaryngology–Head and Neck Surgery, Director of the Division of Laryngology, and Medical Director of the Voice and Swallowing Center at Columbia University Medical Center in New York, developed FEESST and is an expert consultant for Medtronic and Vision Sciences. The technique, he said, “expands the diagnostic options—and hence, the therapeutic options—available to patients who present with throat complaints, including cough.”
Explore this issue:December 2007
Due to its sensory testing component, FEESST captures more complete information on the swallowing mechanism in a wide range of patients. “Without using sensory testing, we have to infer information based on pooling of secretions or how patients respond to our touching them with the tip of the scope in the larynx or pharynx,” explained speech and language pathologist Lori M. Burkhead, PhD, Assistant Professor in the Department of Otolaryngology at the Medical College of Georgia in Augusta. “FEESST gives us a more objective, quantifiable measurement not only for clinical procedures and clinical information, but also for our research endeavors.”
Quantifying the range of laryngeal sensory deficits is especially important in patients with neurological disorders. It is well known that stroke patients are at high risk for aspiration pneumonia, a leading cause of death following stroke. Many studies have now established the technique’s efficacy in the diagnosis and management of patients who are at risk for aspiration;1,2 a few investigators have also shown the procedure to be safe in children.3
In addition to eliminating radiation exposure and the risk of barium aspiration, FEESST’s other advantages include its portability. It is regularly performed in physicians’ offices, clinics, and at the bedside in skilled nursing facilities and nursing homes and even in the ICU. Just prior to performing FEESST, the clinician completes a 30-second calibration with a portable computer and video monitor. He or she then passes an endoscope, which incorporates a sensory stimulator, through the nose and into the oropharynx. The video monitor allows the endoscopist to visually assess velopharyngeal closure, anatomy of the base of the tongue and hypopharynx, abduction and adduction of the vocal folds, status of the pharyngeal musculature, and the patient’s ability to handle his or her own secretions.