Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing ("SIRFES") in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia.
M Scharitzer, I Roesner, P Pokieser and 2 others
PMID 30767078WHAT IT FOUND
After head and neck cancer surgery and radiotherapy, FEES and VFSS done together gave different swallowing scores.
VFSS detected aspiration missed by FEES in 16 of 202 swallows; FEES scored more residue.
Key findings
01When FEES and VFSS were performed at the same time, they gave different penetration-aspiration ratings.
02VFSS detected aspiration in 16 of 202 swallows from ten patients that FEES did not detect.
03FEES scored larger pharyngeal residues than VFSS in the valleculae and piriform sinus.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study analysed 29 patients, and the group was heterogeneous in tumour site, radiotherapy timing, feeding status and tracheostomy use. The comparison only looked at variables thought to be assessable by both tests, so it did not test each method's unique strengths. Many patients had severe swelling and secretions, which limited FEES visibility. Video review was done without sound, so cough responses were not available. Raters were highly experienced, so agreement may not match less experienced readers.
The easy way to misread this
Do not conclude that FEES alone can safely rule out aspiration in this population. VFSS detected aspiration missed by FEES in 16 of 202 swallows, and the authors state the two methods are not interchangeable.