Swallowing

FEES in a COVID-19 WORLD

Benefits of Mobile Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in a COVID 19 World
 
  • Why Are Instrumental Assessments so Important for SLPs and Patients?
     

    • Allow us to view anatomy and physiology

    • Determine the pathophysiology of the swallow

    • Establish an accurate, evidence-based and concise plan of care

    • Clinical swallow evaluations (CSE) do not provide the information needed to assess swallow function (this is our initial evaluation serving to determine if we believe a patient is at risk for aspiration/dysphagia)
       

  • In a subcommittee report based on review of over 150 articles, McCullough et al. (2003) reported that no data existed to support the use of the CSE to evaluate any of the physiologic measures deemed necessary for complete examination of swallowing function.

    • “If the clinical (bedside) evaluation does not provide sufficient information to allow for confident patient management, an instrumental assessment should be performed” (Leder & Murray, 2008, p. 788).

  • Dysphagia causes patients to have difficulty eating and drinking. What happens when you don’t drink enough fluids? The patient is at increased risk for dehydration, malnutrition, electrolyte imbalance, sepsis, and/or a UTI. (Richard, 2018, slide 29)

    • All 5 of those conditions equate for 78% of all 30 day re-hospitalizations. (Mor et. al, 2010)
       

  • At the bedside, without any sort of instrumental, SLPs are over diagnosing dysphagia 70% of the time, using clinical signs and symptoms to create a diagnosis that doesn’t exist (Leder, 2002). SLPs are also missing SILENT aspiration at the bedside 14% of the time (Leder, 2002).

American Academy of Otolaryngology - Head and Neck Surgery, 2020

American Academy of Otolaryngology. (2020). Guidance for return to practice for otolaryngology-head and neck surgery: Part one. https://www.entnet.org/sites/default/files/uploads/guidance_for_return_to_practice_part_one_update_070120.pdf

 

Daniels, S. K., & Huckabee, M. L. (2008). Dysphagia following stroke. Plural Publishing. 

 

Fritz, M. A., Howell, R. J., Brodsky, M. B., Suiter, D. M., Dhar, S. I., Rameau, A., Richard, T., Skelley, M., Ashford, J. R., O'Rourke, A. K., & Kuhn, M. A. (2020, Jun 9). Moving forward with dysphagia care: Implementing strategies during the COVID-19 pandemic and beyond. Dysphagia. https://doi.org/10.1007/s00455-020-10144-9

 

Leder, S. B., & Espinosa, J. F. (2002). Aspiration risk after acute stroke: Comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia, 17(3), 214-218.

 

Leder, S. B., & Murray, J. T. (2008). Fiberoptic endoscopic evaluation of swallowing. Physical Medicine and Rehabilitation Clinics of North America, 19(4), 787-801.

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Arkansas

Phone: 870-373-2552

E-mail: brooke@speechandswallowingsoar.com

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