Authors (including presenting author) :
Yip CY(1), Mo KN(2), Chan KW(1), Wong YH(1), Wong KR(1)
Affiliation :
(1)Speech Therapy Department, Queen Mary Hospital
(2)Speech Therapy Department, Tung Wah Hospital
Introduction :
Flexible Endoscopic Evaluation of Swallowing (FEES) and Videoflurosocopic swallowing study (VFSS) are both reliable and valid instrumental examinations for assessing penetration and aspiration in dysphagic patients. Both examinations are crucial to assess swallowing function, facilitate speech therapists (ST) on clinical decision making and treatment planning. FEES also provided extra clinical information on vocal cords movement, saliva management and allow direct visualization of the effectiveness of compensation strategies. FEES has been adopted as one of the instrumental swallowing examinations since 2012 in HKWC which provided an alternative for inpatients with radiation exposure concern and/or mobilization limitation.
Objectives :
To evaluate the clinical outcome of ST-led FEES
Methodology :
This study was undertaken retrospectively to evaluate the clinical outcomes of FEES in inpatient setting. Patients identified with pharyngeal dysphagia at bedside swallowing assessments by ST were recruited for FEES. From March 2021 to October 2022, 118 inpatient bedside FEES examinations were performed at Queen Mary Hospital and Tung Wah Hospital. The incidence of penetration and aspiration, pharyngeal pooling, diet modification, swallowing maneuvers adaptation and number of examination guiding further treatment planning were evaluated.
Result & Outcome :
Among the bedside FEES examination, 21.2% of examinations were done for patients staying at ICU/ HDU, while 78.8% were done at general ward. Silent aspiration and deep penetration were detected in 33.9% and 40.7% of the inpatients respectively. Pharyngeal pooling was detected in 43.2% of examinations. Based on the FEES findings, 42.4% of inpatients on non-oral feeding/ kept NPO were recommended to resume oral feeding, 55.9% of patients continued non-oral feeding. FEES examination facilitated the decision of intensive swallowing training in 47.5% of the examinations. Vocal cords abnormalities were newly identified in 9 patients, which required subsequent Ear Nose and Throat (ENT) consultation for diagnosis and further management. All endoscopic procedures were carried out without any complication such as epistaxis or vasovagal syncope.
ST-led bedside FEES can be safely conducted in inpatient settings to evaluate swallowing function without concerns of radiation exposure and patients’ mobility. ST-led FEES also provided an effective and efficient evaluation of swallowing functions. It facilitated recommendations on mode of feeding, appropriate diet prescription, implementation of swallowing maneuvers, and further treatment planning. It also enhanced timely rehabilitation and early resumption of oral feeding.
