FEESST - A NEW BEDSIDE ENDOSCOPIC TEST OF THE MOTOR AND SENSORY COMPONENTS OF SWALLOWING

We here introduce an office or bedside method of evaluating both the m otor and sensory components of swallowing, called fiberoptic endoscopi c evaluation of swallowing with sensory testing (FEESST). FEESST combi nes the established endoscopic evaluation of swallowing with a techniq ue that determines laryngopharyngeal (LP) sensory discrimination thres holds by endoscopically delivering air pulse stimuli to the mucosa inn ervated by the superior laryngeal nerve. Endoscopic assessment of LP s ensory capacity followed by endoscopic visualization of deglutition wa s prospectively performed 148 times on 133 patients with dysphagia ove r an 8-month period. The patients had a variety of underlying diagnose s, with stroke and chronic neurologic disease predominating (n = 94). Subsequent to LP sensory testing, a complete dysphagia evaluation was conducted. Various food and liquid consistencies were dyed green, and attention was paid to their management throughout the pharyngeal stage of swallowing. Evidence of latent swallow initiation, pharyngeal pool ing and/or residue, laryngeal penetration, laryngeal aspiration, and/o r reflux was noted. Recommendations for therapeutic intervention were based on information obtained during the FEESST and often involved the employment of compensatory swallowing strategies, modification of the diet or its presentation, placement on non-oral feeding status, and/o r referral to other related specialists. All patients successfully com pleted the examination. In 111 of the evaluations (75%), severe (>6.0 mm Hg air pulse pressure [APP]) unilateral or bilateral LP sensory def icits were found. With puree consistencies, 31% of evaluations with se vere deficits, compared to 5% of evaluations with either normal sensit ivity or moderate (4.0 to 6.0 mm Hg APP) LP sensory deficits, displaye d aspiration (p < .001, chi 2 test). With puree consistencies, 69% of evaluations with severe deficits, compared to 24% with normal or moder ate deficits, displayed laryngeal penetration (p < .001, chi(2) test). FEESST allows the clinician to obtain a comprehensive bedside assessm ent of swallowing that is performed as the initial swallowing evaluati on for the patient with dysphagia.