Instrumental Evaluation of Pediatric Dysphagia: FEES Versus Videofluoroscopy

Introduction Problems with swallowing, dysphagia, can occur in infants and children, which may have devastating effects. When a child with dysphagia is not treated properly, it may cause aspiration pneumonia, gastroesophageal reflux, and inability to develop and maintain adequate nutrition and hydration, and failure to thrive. This is why it is critical to properly evaluate children that are showing signs and/or are at risk for dysphagia (Prasse & Kikano, 2009). Instrumental assessments provide images of the oral, pharyngeal, and upper esophageal phases of swallowing and are generally used to address particular diagnostic questions which may determine what type of therapy would be beneficial (Arvedson, 2008; Rogers and Arvedson, 2005). The two most common types of instrumental assessments to evaluate dysphagia are videofluoroscopy (aka Modified Barium Swallow examination, MBS, or VFSS) and FEES (aka videoendoscopy or flexible fiberoptic examination of swallowing). Over the years, there has been a debate about whether FEES/FEEST or videofluoroscopy is, or should be, the " gold-standard " for assessing dysphagia. However, there has been a lack of research that directly compares them, and an even smaller number of investigations that have concentrated on the pediatric population. The focus of this research paper is to compare and contrast the use of FEES versus MBS for pediatric dysphagia evaluations. First, a description of each instrumental evaluation tool is provided followed by a discussion of the strengths and limitations of each procedure. VFSS and FEES can be compared based on each procedure's ability to enable feedback during intervention, assess sensory threshold, evaluate and diagnose GER, provide patient comfort, and assess a wide range of appropriate candidates. There 2 are limited studies that have attempted to compare VFSS and FEES directly in their ability to assess pediatric dysphagia, but a discussion of these studies can provide some insight for clinicians contemplating the use of instrumental assessment procedures. Instrumental Assessments FEES/FEES-ST Flexible endoscopic examination of swallowing (FEES) is one type of instrumental evaluation that is generally performed by a SLP and a pediatric otolaryngologist both working together. A flexible endoscope is inserted through the client's nose and is held in place so that the examiner(s) can observe the events that transpire right before and after the pharyngeal swallow. During this evaluation, the examiner(s) may also wish to administer a sensory test (FEESST), which uses air pressure to test laryngeal reflexes (Arvedson, 2008). VFSS Another instrumental examination is the videofluoroscopic swallow study …