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Dysphagia > FEES > Flashcards

FEES Flashcards

Exam 2

1
Q

Between FEES and VFSS (MBSImP), which one is the “gold standard”?

A

Neither!

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2
Q

List the three components of the Langmore FEES protocol.

A
  1. Anatomy and Physiology Assessment
  2. Swallowing Assessment
  3. Intervention Implementation
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3
Q

What are some normal anatomical variations that may effect swallow performance?

A

Low aryepiglottic folds create shallow lateral channels
Arytenoids resting close to posterior pharyngeal wall may decrease post-cricoid space
Epiglottis resting on tongue obliterates valleculae
Epiglottis resting posteriorly may enlarge valleculae
Narrow hypopharyngeal space
Epiglotti come in all shapes and sizes

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4
Q

In normal swallowing, there is an overlap between what two stages?

A

Oral and pharyngeal

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5
Q

In a normal swallow, how long can solid material collect in the valleculae during the mastication phase?

A

Up to 10 seconds in normal adults

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6
Q

True or False?Liquids may reach the pyriform sinuses prior to swallow onset in normal, healthy adults.

A

True. Dwell time 1-2 seconds. Tends to be longer for smaller amounts.

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7
Q

PAS of 2 or “flash” penetration is considered disordered or normal?

A

Normal

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8
Q

True or False:

Silent aspiration can be seen in normal healthy adults.

A

True!

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9
Q

In FEES, what are the four salient findings?

A

Swallow Onset
Residue
Penetration
Aspiration

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10
Q

Describe “Swallow onset”

A

Where does the bolus fall prior to swallow onset/initiation? Pyriform sinus? vallecula? PPW?

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11
Q

What is residue?

A

Bolus remains in hypopharyngeal cavities after the swallow. More than a coating; enough substance for remains to flow.

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12
Q

What is penetration?

A

Bolus material enters the laryngeal vestibule, over the rim of the larynx

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13
Q

What is aspiration?

A

Bolus material passes below the true vocal folds.

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14
Q

Where can residue occur?

A

Almost anywhere along the path! Most commonly: valleculae, pyriform sinus, and posterior pharyngeal wall.

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15
Q

If you observe vallecular residue, what could be 2 possible reasons?

A

Insufficient tongue base retraction/propulsion

Insufficient hyolaryngeal elevation reducing epiglottic inversion

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16
Q

If you observe residue in the pyriform sinusus, what could be 2 reasons?

A

Reduced hyolaryngeal elevation

Insufficient UES opening

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17
Q

What is the most important question when it comes to penetration/aspiration?

A

WHEN it happens.

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18
Q

What are some reasons (3) why penetration or aspiration might occur?

A

Reduced oral control/BOT retraction

Mistimed or reduced hyolaryngeal elevation, laryngeal vestibule closure & sealing

Inability to clear residue

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19
Q

Can you see the esophageal phase in the FEES?

A

Not technically. But we can see symptoms that may cue us to refer them for more testing, such as backflow causing after-swallow aspiration.

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20
Q

If you observe backflow or bubbling up from the UES, what are some (2) reasons this could be happening?

A

Air in esophagus

Retrograde movement of material in the esophagus

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21
Q

What are some structural problems to look for?

A

Incomplete closure of one or both TVCs/Inadequate airway protection.

Narrowed pharyngeal lumen.

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22
Q

What are some reasons why we might observe incomplete closure of one or both TVCs/inadequate airway protection? What could be an underlying cause of this?

A

Impaired neural signal to laryngeal muscles

Damage to tissue causing immobility (scarring)

Underlying Cause:
Neurological event
CVA
Trauma
Surgery
Neoplasm
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23
Q

What are some reasons we might observe a narrowed pharyngeal lumen?
What could be an underlying cause of this?

A

Structural blockage
Bulky tissue

Underlying Cause:
Osteophyte
Congenital defect
Large body habitus

24
Q

What “other information” are we looking for during a FEES?

A

respiration capabilities

25
Q

What are we looking for in respiration abilities with the FEES?

A

Subtle adduction and abduction mirrors inspiration and expiration.

During rest breathing only the vocal folds and arytenoids should move

Swallowing usually occurs at the beginning of exhalation

Respiratory muscle fatigue associated with swallowing disorders

FEES allows observation of breathing/swallowing patterns

26
Q

What does FEES Stand for?

A

Fiberoptic
Endoscopic
Evaluation of
Swallowing

27
Q

What is a videoflouroscopic swallow study? Is it the same as FEES?

A

AKA: Modified barium swallow

So….no, it’s different.

28
Q

When was the first publication of FEES?

A

1988

29
Q

What are some aspects, per Dr. Langmore, that FEES offers (that VFSS doesn’t)?

A

Visualization of secretions

Direct view of surface anatomy,

Mucosal abnormalities (edema, erythema)

Observation of effects of altered anatomy on bolus flow and airway protection

Visualization of glottic closure

Clear observation of the bolus path and location of the bolus within the hypopharynx

30
Q

What are some aspects, per Dr. Langmore, that VFSS offers (that FEES doesn’t)?

A

Visualization bolus during the height of the swallow

Analysis of both oral and esophageal phase

Observation of completeness of BOT retraction, UES opening, and extent of aspiration

View of submucosal changes (osteophytes, metal plates)

31
Q

What does ASHA say about Fiberoptic endoscopy and SLPs?

A

That it is an imaging procedure that may be utilized by SLPs to evaluate swallowing function, as a therapeutic aid & biofeedback tool during swallow treatment.

Assessment & Management of Dysphagia falls within the scope of SLPs.

32
Q

Is there a FEES certification?

A

No, except in TN. According to ASHA Code of Ethics: “Individuals shall engage in the provision of the professions that are within the scope of their competence, considering their level of education, training, and experience.”

So, know your stuff.

33
Q

What are the four main components of the FEES equipment?

A

Nasoendoscope

Light Source

Camera with Endoscopic lens coupler

Video/Audio recording device

34
Q

Do we sterilize or disinfect a FEES endoscope?

A

No, we disinfect

35
Q

What is sterilization?

A

Elimination of ALL microorganisms & bacterial spores

Methods:
Autoclaving: high temperature & pressure
Not recommended for most endoscopes. May destroy adhesives used to manufacture scopes causing leaking and scope fogging.

36
Q

Why don’t we sterilize the nasoendoscope?

A

Our nose and mouth are no sterile. Only sterile equipment for surgery.

37
Q

What is disinfection?

A

Not complete elimination.

Scope is immersed in a solution for a specified soaking period.

38
Q

List the steps in the commonly used disinfecting procedure.

A 
Pre-cleaning 
Rinse 
Leak Testing
High Level Disinfection
Rinse
Drying
Storage
39
Q

What is the first action of a swallow onset?

A

Movement of arytenoids to the mid line (VF adduction)

40
Q

How is swallow initiation seen in flouroscopy?

A

Hyoid bone/laryngeal elevation.

41
Q

What does the whiteout indicate?

A

Epiglottic inversion.

42
Q

What is pharyngeal shortening?

A

When the lateral pharyngeal walls medialize and there is sequential contraction of pharyngeal constrictor muscles (stripping)

43
Q

UES opening is tied with…

A

hyolaryngeal elevation

44
Q

Is the completeness of UES opening better seen with VFSS or FEES?

A

VFSS

45
Q

How does the UES open?

A

As larynx lifts up and forward, the UES is traction open (along with cricopharyngeal relaxation) allowing the bolus to pass into the esophagus

46
Q

When passing the scope, how should you start?

A

Insert the endoscope slightly into each naris and assess the anatomy

Determine which side has the clearest opening or ask patient if they breathe better through one side.

Remove any debris by having patient blow nose

47
Q

How do we assess VP competence?

A

have them say “donut”

Both nasal and oral sounds to stimulate VP closure.

48
Q

What kind of abnormalities are we looking for?

A

Bumps, discoloration, secretions, asymmetry, etc.

49
Q

Describe the “Pre-swallow Position”

A

Camera is above the epiglottis, with a view of the base of the tongue and the entire hypopharynx & larynx

50
Q

Describe the “Post-Swallow Position”

A

Descend into larynx vestibule.
View vocal folds and subglottic region.
Quickly retract to pre-swallow position.

51
Q

What does “whiteout” refer to?

A

Bright flash of white light reflected off the tissue surface back into scope

52
Q

Where are the two possible locations we can experience whiteout?

A

High position: velum can trap end of scope against the posterior wall during elevation

Pre-Swallow Position: hyolaryngeal elevation with epiglottis retroflex may obliterate view momentarily

53
Q

List some complications with using the endoscope.

A

Sneezing (uncommon)
Epistaxis (uncommon)
Laryngospasm (rare)
Vasovagal response (extremely rare)

54
Q

List some advantages for the FEES.

A 
Can be administered 
at bedside
with most pts, including bariatric
in natural head postures
repeatedly
without anesthesia
for prolonged periods (fatigue during meals)
Allows additional assessment of larynx & its functions
Realistic estimates of stasis and secretions
Visualize bolus flow directions
May demonstrate effects of compensatory approaches maneuvers
Staff SLP actively participates
Uses real food/consistencies
Inexpensive procedure
Higher reimbursement rate
ICU and isolation patients
Biofeedback
55
Q

List some advantages of the MBSS.

A

Visualizes oral, pharyngeal & cervical esophageal structures
Visualizes whole oropharyngeal swallow event
Can provide special measures (biomechanical,temporal)
May demonstrate effects of
compensatory approaches
maneuvers
Can be administered to most patients

56
Q

List some disadvantages of the FEES.

A 
Does not visualize oral cavity
Does not visualize the moment of swallow (whiteout)
Potential for
Mild discomfort
Gagging
Nose bleeds (epitaxis) 
Laryngospasm or vasovagal response
Difficult with combative pts
Nasal/pharyngeal debris with heavy O2 users
57
Q

List some disadvantages of the MBSS.

A

Uses radiation with limited exposure time
Mostly administered in a radiological suite
Uses barium sulfate mixed with food
Alters natural consistency
Unnatural head positioning
Requires radiologist or technician
Referring SLP not always active participant
Expensive
Unable to view secretions
Transportation to Radiology

Dysphagia (17 decks)

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