FEES & MBSS

Question 1

FEES

Answer 1

flexible endoscopic evaluation of swallowing

Question 2

the jest of FEES

Answer 2

placed transnasally and allows SLP to view the swallow immediately before and after triggering of the swallow reflex

Question 3

what can be observed via FEES (10)

Answer 3

VP closure; structural integrity of the larynx / pharynx; excess secretions; sensation (by touching epiglottis or arytenoid cartilage); TVC adduction / abduction; dry swallows; clearing of secretions; blue dyed food / liquid; premature spilling / pooling; penetration / aspiration; pharyngeal residue

Question 4

FEES allows you to check effectiveness of ___ (3)

Answer 4

effectiveness of reflexive / voluntary coughs; effectiveness of dry swallow to clear residue; effectiveness of various postures and compensatory maneuvers

Question 5

benefits of FEES (4)

Answer 5

observe structure; able to see its bedside; no radiation; biofeedback

Question 6

MBSS

Answer 6

modified barium swallow study

Question 7

the jest of MBSS

Answer 7

the oral cavity, pharynx, and sometimes upper portion of the cervical esophagus is viewed radiographically in a lateral view primarily, with some anterior views

Question 8

usual order to give consistencies (5)

Answer 8

thin liquids, thick liquids, puree, soft solid, regular solid

Question 9

___ and ___ consistencies are usually given first in abnormally small amounts

Answer 9

liquid and puree consistencies

Question 10

give consistencies starting with .5 - 1 tsp, then ___, then ___, then allowing the patient to feed themselves

Answer 10

sips; serial sips / gulps

Question 11

a very small amount of liquid is usually started with because ___ (2)

Answer 11

it is easiest to clear from the airway and the amount of aspiration will be less; the first swallow screens the swallow and helps to determine the patient’s degree of dysphagia

Question 12

MBSS oral stage (4)

Answer 12

bolus formation, bolus maintenance, bolus transit / propulsion; check for oral residue; check for premature spillage; check ability to chew / masticate

Question 13

MBSS pharyngeal stage: position of bolus when swallow is triggered (3)

Answer 13

up to 0:03 : mild delay :: 0:03 - 0:05 : moderate delay :: 0:05+ : severe delay

Question 14

MBSS pharyngeal stage: check for ___ (10)

Answer 14

timeliness (delay) of swallow; timing of VP closure; BOT retraction; epiglottic inversion / retroflexion; hyoid movement / laryngeal elevation; contraction of pharyngeal constrictors; CP / UES relaxation / opening; amount of laryngeal penetration; amount of aspiration; amount of placement of pharyngeal residue

Question 15

MBSS pharyngeal stage: when there’s laryngeal penetration, ask ___ (3)

Answer 15

how deep does it go? is there a cough? does it clear?

Question 16

MBSS pharyngeal stage: when there’s aspiration, ask ___ (2)

Answer 16

is it silent? if not silent, does the cough clear it?

Question 17

MBSS pharyngeal stage: when there’s placement of pharyngeal residue, ask ___

Answer 17

how much is cleared with a repeat dry swallow?

Question 18

MBSS esophageal stage: which structure is viewed?

Answer 18

portions of the cervical esophagus (varies across individuals)

Question 19

MBSS esophageal stage: what may we see? (2)

Answer 19

back flow of food / liquid; food / liquid sticking in or clearing slowly through the cervical esophagus

Question 20

MBSS structural integrity: what may we see? (3)

Answer 20

zener’s diverticulum; cervical osteophytes; head and neck cancer symptoms (resected structures, lymph edema, fistulas, pseudovallalae)

Question 21

disadvantages of MBSS (2)

Answer 21

radiation; you have to move the patient from their room