FEES Flashcards
Exam 2
Between FEES and VFSS (MBSImP), which one is the “gold standard”?
Neither!
List the three components of the Langmore FEES protocol.
- Anatomy and Physiology Assessment
- Swallowing Assessment
- Intervention Implementation
What are some normal anatomical variations that may effect swallow performance?
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
In normal swallowing, there is an overlap between what two stages?
Oral and pharyngeal
In a normal swallow, how long can solid material collect in the valleculae during the mastication phase?
Up to 10 seconds in normal adults
True or False?Liquids may reach the pyriform sinuses prior to swallow onset in normal, healthy adults.
True. Dwell time 1-2 seconds. Tends to be longer for smaller amounts.
PAS of 2 or “flash” penetration is considered disordered or normal?
Normal
True or False:
Silent aspiration can be seen in normal healthy adults.
True!
In FEES, what are the four salient findings?
Swallow Onset
Residue
Penetration
Aspiration
Describe “Swallow onset”
Where does the bolus fall prior to swallow onset/initiation? Pyriform sinus? vallecula? PPW?
What is residue?
Bolus remains in hypopharyngeal cavities after the swallow. More than a coating; enough substance for remains to flow.
What is penetration?
Bolus material enters the laryngeal vestibule, over the rim of the larynx
What is aspiration?
Bolus material passes below the true vocal folds.
Where can residue occur?
Almost anywhere along the path! Most commonly: valleculae, pyriform sinus, and posterior pharyngeal wall.
If you observe vallecular residue, what could be 2 possible reasons?
Insufficient tongue base retraction/propulsion
Insufficient hyolaryngeal elevation reducing epiglottic inversion
If you observe residue in the pyriform sinusus, what could be 2 reasons?
Reduced hyolaryngeal elevation
Insufficient UES opening
What is the most important question when it comes to penetration/aspiration?
WHEN it happens.
What are some reasons (3) why penetration or aspiration might occur?
Reduced oral control/BOT retraction
Mistimed or reduced hyolaryngeal elevation, laryngeal vestibule closure & sealing
Inability to clear residue
Can you see the esophageal phase in the FEES?
Not technically. But we can see symptoms that may cue us to refer them for more testing, such as backflow causing after-swallow aspiration.
If you observe backflow or bubbling up from the UES, what are some (2) reasons this could be happening?
Air in esophagus
Retrograde movement of material in the esophagus
What are some structural problems to look for?
Incomplete closure of one or both TVCs/Inadequate airway protection.
Narrowed pharyngeal lumen.
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?
Impaired neural signal to laryngeal muscles
Damage to tissue causing immobility (scarring)
Underlying Cause: Neurological event CVA Trauma Surgery Neoplasm
What are some reasons we might observe a narrowed pharyngeal lumen?
What could be an underlying cause of this?
Structural blockage
Bulky tissue
Underlying Cause:
Osteophyte
Congenital defect
Large body habitus
What “other information” are we looking for during a FEES?
respiration capabilities
