FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING WITH SENSORY TESTING (FEESST) IN HEALTHY CONTROLS

The purpose of this study was to introduce a new method of bedside ass essment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (F EESST). This approach combines the established bedside endoscopic swal lowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discriminat ion thresholds by delivering air pulse stimuli to the mucosa innervate d by the superior laryngeal nerve via a flexible endoscope. A prospect ive study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (<4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (>6.0 mmHg APP). Subsequent to LP senso ry testing, food of varying consistencies, mixed with green food color ing, was given and attention was paid to spillage, laryngeal penetrati on, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were perform ed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). Th ere were no instances of spillage, laryngeal penetration, or aspiratio n. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. I nstitution of therapeutic maneuvers resulted in a predictable change i n the endoscopic view of the laryngopharyngeal anatomy. FEESST provide s comprehensive, objective sensory and motor information about degluti tion in the bedside setting and might have implications for the bedsid e diagnosis and management of patients with dysphagia.