Swallowing Exams

Question 1

What does FEES stand for?

Answer 1

Flexible endoscopic evaluation of swallowing

Question 2

What does FEES allow you to view? (Hint: 7)

Answer 2

The swallow immediately before and after the triggering of the swallow reflex
Premature spillage/pooling
Penetration/aspiration
Pharyngeal residue
Effectiveness of cough
Effectiveness of dry swallow
Effectiveness of compensatory measures

Question 3

How do you test sensation using FEESST?

Answer 3

Provide a puff of air using the endoscopic scope (for places we can’t touch)

Question 4

What can you see when using FEES?

Answer 4

Can observe VP closure
Can see structural integrity of larynx/pharynx
Can assess secretions
Can see tissue color/texture
Can see true vocal fold adduction/abduction

Question 5

What are the benefits of FEES? (Hint:6)

Answer 5

Observe structure
Able to see patient bedside 
No radiation 
Biofeedback 
Can complete the exam frequently
Can do exam for long periods of time (if pt can handle it)

Question 6

What’s the order of consistencies given for the MBSS?

Answer 6

Thin liquid (1/2 teaspoon, small sip, regular gulp from cup/half cup of liquid)
Thick liquids (nectar > honey (same as above))
Purée (applesauce/ pudding)
Soft solid (fig Newton, short bread cookie)
Solid (bagel)

Question 7

T/F: provide 3 swallows to make sure the client is capable of swallowing properly

Answer 7

TRUE

Question 8

Which consistencies should be given first in the MBSS?

Answer 8

Liquid and purées

Question 9

What are the benefits of MBSS? (Hint: 4)

Answer 9

See every stage of the swallow
See how maneuvers/postures work
Can test all consistencies of food and liquids
Can screen esophageal stage

Question 10

T/F: we do not need to see the patient swallow anteriorly during MBSS exam

Answer 10

False! We should get at least one view anteriorly to check for asymmetry

Question 11

Aside from the swallow, what are two other disadvantages of FEES?

Answer 11

Can’t see esophageal stage

Can’t see oral stage

Question 12

How should you write about aspiration in a report?

Answer 12

Try to quantify the amount of aspiration

Question 13

Name two exams that can be used to evaluate swallowing

Answer 13

FEES

MBSS/VFSS

Question 14

Name 3 disadvantages of FEES

Answer 14

CANNOT see the ACTUAL SWALLOW
Can’t see esophageal stage
Can’t see oral phase

Question 15

What is the most difficult thing about dysphasia treatment according to Dr. Biel?

Answer 15

Trying to get the patient to follow your treatment recommendations

Question 16

Name 3 ways to get patients to do what you want them to do

Answer 16

Give pt rationale of why they should maintain diet you recommend
Control- DO NOT show them a different side of you when they don’t do what you want
Acknowledge pt feels-don’t hide that you know it sucks

Question 17

When is the anterior-posterior view screen? Why?

Answer 17

At the end of the study w/ thin or thick boluses

Can view symmetry of bolus, residue, observe anatomical abnormalities

This is the time to screen esophagus

Question 18

What are some postural changes that can be used in swallowing? Why are they used?

Answer 18

Chin tuck-used with poor oral control with premature spillage

Head turn-promotes passage of bolus through stronger side of the pharynx

Question 19

Which postural change is most often given without a modified barium swallow?

Answer 19

Chin tuck

Question 20

Which postural change is the most difficult to predict?

Answer 20

Chin tuck

Can also make the swallow worse

Question 21

Why are postural changes/compensatory maneuvers used?

Answer 21

To improve airway protection and/or improve oral and/or pharyngeal transit of food/liquid

Question 22

What maneuver strategies should be used?

Answer 22

Effortful swallow
Supraglottic swallow
Mendelsohn maneuver
Masako
Take really small sips

Question 23

What is most important thing to do when recommending compensatory maneuvers?

Answer 23

Verifying that the strategies work under videofluroscopy

Question 24

Complaints of something sticking in the sternum with no other signs of dysphasia is a sign of…

Answer 24

Esophageal stage dysphasia