Role of fiberoptic endoscopic evaluation of swallowing in evaluating the pharyngeal phase of swallowing in patients with dysphagia: a cross-sectional study

Preetham Achoor Puthukudy; Musarrat Feshan; Anitha Balakrishnan

doi:10.18203/issn.2454-5929.ijohns20260747

Authors

Preetham Achoor Puthukudy Department of Otorhinolaryngology, Southern Railway Headquarters Hospital, Ayanavaram, Chennai, India
Musarrat Feshan Department of Otorhinolaryngology, Southern Railway Headquarters Hospital, Ayanavaram, Chennai, India
Anitha Balakrishnan Department of Otorhinolaryngology, Southern Railway Headquarters Hospital, Ayanavaram, Chennai, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20260747

Keywords:

Aspiration, Dysphagia, FEES, Pharyngeal phase, Penetration aspiration scale, Swallowing

Abstract

Background: Dysphagia or difficulty in swallowing, is a common symptom of various etiologies. The pharyngeal phase of swallowing is particularly critical for safe deglutition. FEES is a reliable, non-invasive diagnostic tool to evaluate this phase. The article’s main purpose is to estimate the prevalence and etiological profile of pharyngeal phase disorders using FEES in patients presenting with dysphagia and to analyze associated clinical and sociodemographic variables. The Associations were calculated by the Chi-square and Fisher's exact tests. Cramer’s coefficient calculates the strength of association. SPSS version 20 was used for statistical analysis.

Methods: In this descriptive cross-sectional study, 150 patients presenting with dysphagia were subjected to FEES using standard protocols. Data on demographics, clinical diagnoses and findings, including residue, whiteout, penetration, aspiration and sensation, were analyzed.

Results: In the study, the most common diagnosis was laryngopharyngeal reflux (20%), followed by carcinoma (16%). FEES findings revealed residues for solids in 29.3%, semisolids in 16% and liquids in 12.7%. Aspiration was observed in 4% for liquids and 2.7% each for semisolids and solids. Sensation was abnormal in 0.67% of the patients. A significant association was found between occupation and FEES findings (p=0.012) and between FEES and PAS scores (p=0.001).

Conclusions: FEES is an effective tool for evaluating pharyngeal dysphagia and identifying the risk of aspiration. It allows real-time assessment and supports tailored management strategies.

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References

Hennessy M, Goldenberg D. Surgical anatomy and physiology of swallowing. Operative Techn Otolaryngol Head Neck Surg. 2016;27(2):60-6. DOI: https://doi.org/10.1016/j.otot.2016.04.002

Pekáriková Z. Dysfagie a její vliv na stravování a sociální interakce. Missouri Med. 2018;115:206-10.

Langmore SE, Kenneth SMA, Olsen N. Fiberoptic endoscopic examination of swallowing safety: A new procedure. Dysphagia. 1988;2(4):216–9. DOI: https://doi.org/10.1007/BF02414429

Datta G, Gupta M, Rao N. Clinical profile of cases of dysphagia presenting in ENT department: A study from rural tertiary care center. Int J Otorhinolaryngol Head Neck Surg. 2017;3(3):639-45. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20173039

Braun T, Juenemann M, Viard M, Meyer M, Reuter I, Prosiegel M. Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study. BMC Neurol. 2019;19(1):282. DOI: https://doi.org/10.1186/s12883-019-1499-8

Braun T, Juenemann M, Viard M, Meyer M, Fuest S, Reuter I, et al. What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients. A cross-sectional hospital-based registry study. BMJ Open. 2018;8(3):19016. DOI: https://doi.org/10.1136/bmjopen-2017-019016

Kwon M, Lee JH. Oro-pharyngeal dysphagia in Parkinson’s disease and related movement disorders. J Mov Disord. 2019;12(3):152. DOI: https://doi.org/10.14802/jmd.19048

Duval M, Ayad T, Guertin L, Rousseau J, Soulières D, Tabet JC. Role of Fiberoptic endoscopic evaluation of swallowing (FEES) in the workup of the head and neck patient. J Otolaryngol. 2004;33(4):213-6.

Agur A, Dalley A. Grant’s Atlas of Anatomy (12th edition). Ref Rev. 2009;16;23(1):44–5. DOI: https://doi.org/10.1108/09504120910925788

Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases. 2023;11(11):2363–73. DOI: https://doi.org/10.12998/wjcc.v11.i11.2363

Devan P, Kailliath J. A diagnostic modality in dysphagic patients-FEES (Functional Endoscopic Evaluation of Swallowing). J Otorhinolaryngol and Allied Sci. 2019;2:74-6.

Aviv JE, Murry T, Cohen M, Zschommler A, Gartner C. Flexible Endoscopic Evaluation of Swallowing with Sensory Testing: Patient Characteristics and Analysis of Safety in 1,340 Consecutive Examinations. Ann Otol Rhinol Laryngol. 2005;114(3):173–6. DOI: https://doi.org/10.1177/000348940511400301

Chih‐Hsiu W, Tzu‐Yu H, Jiann‐Chyuan C, Yeun‐Chung C, Shiann‐Yann L. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107(3):396–401. DOI: https://doi.org/10.1097/00005537-199703000-00023