Dr. Burkhead also employs FEESST with hospital patients in the ICU setting. “Frequently, patients who have been intubated or who have tracheostomy will become desensitized, because they lose airflow through their upper airway. We know that swallowing function in intubated patients can take 24 to 48 hours after extubation to return to normal. Having sensory information is also useful, because we can better estimate the risk for ‘silent aspiration.’” She is often called by the acute medical team to assess patients following extubation.
Explore This IssueDecember 2007
—Lori M. Burkhead, PhD
Dr. Aviv also emphasizes the role of FEESST in determining the severity of acid reflux disease. “Often, prescribing antacid medication is one of the few things you can do for people with swallowing problems due to neurodegenerative diseases like Parkinson’s,” he said. “FEESST allows you to make that call.” (More information on the specifics of the reflux symptom index and the reflux finding score can be found in Chapter 4 of Dr. Aviv’s book, FEESST: Flexible Endoscopic Evaluation of Swallowing with Sensory Testing, co-written with speech pathologist Thomas Murry, PhD; Plural Publishing, Inc., 2005.)
Dr. Burkhead notes that she can glean information about patients’ physiology and sensation using FEESST without even administering a bolus. This can be especially advantageous in patients at high risk for aspiration, such as those with a compromised pulmonary profile. The endoscope allows her to visually assess how the person is handling secretions, and the sensory testing with the air pulse allows assessment of airway protection. When training other speech pathologists in the technique, she emphasizes that they put their patients at ease by making eye contact during the procedure, moving quickly and projecting confidence. Dr. Aviv notes that patient education materials and video on his center’s Web site (www.voiceandswallowing.com ) can help prepare patients who are to undergo the procedure.
Dr. Burkhead often uses both MBS and FEESST, noting that the latter provides much more information about tissue condition as well as sensation. “Sensory testing,” she said, “is simple, effective, informative, and easy.”
Effects of Smoking on Short-Term QOL After Sinus Surgery
Although much data exist identifying smoking as a risk factor for respiratory diseases, little is known about the effects of smoking on surgical outcomes for chronic rhinosinusitis. As a results of a number of studies and anecdotal findings, many rhinologists recommend against performing endoscopic sinus surgery on active smokers, and most clinicians counsel patients who are smokers to expect worse postoperative outcomes. In a preliminary effort to better understand the exact pathophysiologic mechanisms of smoke damage in patients undergoing endoscopic sinus surgery, Subinoy Das, MD, and associates conducted a review of prospectively collected data on patients who enrolled in a single-institution study on the molecular mechanisms of chronic sinusitis.