What's the Evidence? A Commentary on FEES Research

Purpose: Fiberoptic endoscopic evaluation of swallowing (FEES) is a well-respected swallowing assessment, harking back to 1988 when it was first published by Susan Langmore as a procedure. Since then, its methodology has evolved to afford clinicians, researchers, and patients a sensitive, specific, and predictive exam. A myriad research has investigated FEES technique and its outcomes, rendering it an effective and efficient procedure for swallowing assessment and therapy. This commentary will outline evidence for FEES to support evidence-based practice. What is the evidence for speech tasks? Secretion scales? What is the predictive nature of aspiration as seen on FEES? This comprehensive review will outline the science bolstering the use and confidence in FEES. Conclusions: This commentary reviews studies that have proposed normative data collected via FEES for decision making, specifically when assessing pharyngeal and laryngeal anatomy, bolus spillage, and the white out period. Evidence for FEES sensitivity and predictive aspects are reviewed in relationship to speech tasks, secretions, aspiration and penetration--aspiration scale scores, and pharyngeal residue scales. The acute care advantage of FEES is defined in its use on postextubation populations, assessment of dysphagia in COVID-19 positive patients, and safe evaluation during ice chip administration with acutely ill patients. Finally, inference making on FEES is discussed in regard to epiglottic retroflexion and depth of aspiration. When it comes to assessing pharyngeal dysphagia, the true strengths of FEES are rooted in evidence. It has been shown to be sensitive, predictive, and practical and will likely continue to have stronger support as research continues to enrich its potential.

Evaluating a Prototype Nasolaryngoscopy Hood During Aerosol-Generating Procedures in Otolaryngology.

OBJECTIVE: During the COVID-19 pandemic, there has been considerable interest in identifying aerosol- and droplet-generating procedures, as well as efforts to mitigate the spread of these potentially dangerous particulates. This study evaluated the efficacy of a prototype nasolaryngoscopy hood (PNLH) during various clinical scenarios that are known to generate aerosols and droplets. STUDY DESIGN: Prospective detection of airborne aerosol generation during clinical simulation while wearing an PNLH. SETTING: Clinical examination room. METHODS: A particle counter was used to calculate the average number of 0.3-µm particles/L detected during various clinical scenarios that included sneezing, nasolaryngoscopy, sneezing during nasolaryngoscopy, and topical spray administration. Experiments were repeated to compare the PNLH versus no protection. During the sneeze experiments, additional measurements with a conventional N95 were documented. RESULTS: There was a significant increase in aerosols detected during sneezing, sneezing during nasolaryngoscopy, and spray administration, as compared with baseline when no patient barrier was used. With the PNLH in place, the level of aerosols returned to comparable baseline levels in each scenario. Of note, routine nasolaryngoscopy did not lead to a statistically significant increase in aerosols. CONCLUSION: This study demonstrated that the PNLH is a safe and effective form of protection that can be used in clinical practice to help mitigate the generation of aerosols during nasolaryngoscopy. While nasolaryngoscopy itself was not shown to produce significant aerosols, the PNLH managed to lessen the aerosol burden during sneezing episodes associated with nasolaryngoscopy.

The FEES box: A novel barrier to contain particles during aerosol-generating procedures.

PURPOSE: Due to the COVID-19 pandemic, aerosol-generating procedures (AGPs) such as flexible endoscopic evaluation of swallowing (FEES) have been deemed high-risk and in some cases restricted, indicating the need for additional personal protective equipment. The aim of this study was to erect and study a protective barrier for FEES. MATERIALS AND METHODS: A PVC cube was constructed to fit over a patient while allowing for upright endoscopy. A plastic drape was fitted over the cube, and the protective barrier was subsequently named the "FEES Box." Three different particulate-generating tasks were carried out: sneezing, coughing, and spraying water from an atomizer bottle. Each task was completed within and without the FEES Box, and particulate was measured with a particle counter. The average particles/L detected during the three tasks, and baseline measurements, were statistically compared. RESULTS: Without the FEES Box in place, the sneezing and spraying tasks resulted in a statistically significant increase in particles above baseline (p < 0.001 and p = 0.004, respectively); coughing particulate never reached levels significantly higher than baseline (p = 0.230). With use of the FEES Box, there was no statistically significant increase in particles above baseline in any of the three tasks. CONCLUSION: The FEES Box effectively contained particles generated during sneezes and an atomizer spray. It would also likely mitigate coughing particulate, but coughing did not generate a significant increase in particles above baseline. Further research is warranted to test the efficacy of the FEES Box in containing particulate matter during a complete FEES procedure.