Name of the Procedure:

Flexible Endoscopic Evaluation of Swallowing (FEES) with Laryngeal Sensory Testing by Cine or Video Recording; Interpretation and Report Only

Summary:

This procedure involves using a flexible endoscope to visualize the throat while the patient swallows. A video recording is made for detailed analysis. It tests the sensitivity of the laryngeal area to help diagnose swallowing disorders.

Purpose:

The procedure addresses swallowing difficulties (dysphagia) and evaluates the sensory function of the larynx. It aims to identify the cause of swallowing issues and guide appropriate treatment.

Indications:

• Persistent coughing or choking while eating or drinking
• Frequent pneumonia or respiratory infections due to aspiration
• Unexplained weight loss related to difficulty swallowing
• Neurological conditions affecting swallowing ######## Patient Criteria:
• Patients with suspected or confirmed dysphagia
• Individuals showing signs of aspiration risk

Preparation:

• No eating or drinking for up to 4 hours before the procedure.
• Adjustments to certain medications as directed by the physician.
• Diagnostic tests like a barium swallow study may be required beforehand.

Procedure Description:

1. The patient is seated in an upright position.
2. A topical anesthetic is applied to the nasal passage to minimize discomfort.
3. A flexible endoscope is gently inserted through the nose and down the throat.
4. The patient is asked to perform various swallowing tasks with different consistencies of food/liquids.
5. Sensory testing of the larynx is performed by administering air-puff stimuli.
6. The entire process is recorded on video for detailed analysis.
7. The healthcare provider reviews and interprets the video to generate a report.

## Tools and Equipment:

• Flexible endoscope
• Video recording system
• Topical anesthetics

## Anesthesia:

• Local anesthesia (topical) may be applied to the nasal passage.

Duration:

The procedure typically takes about 20–30 minutes.

Setting:

The procedure is generally performed in an outpatient clinic or an endoscopy suite.

Personnel:

• Otolaryngologist (ENT specialist) or speech-language pathologist
• Nurse or medical assistant

Risks and Complications:

• Minor nasal discomfort or nosebleed
• Gagging or slight discomfort during the procedure
• Rarely, aspiration or respiratory distress ######## Management:
• Post-procedure monitoring by medical staff
• Immediate intervention if complications arise

Benefits:

• Accurate diagnosis of swallowing disorders
• Identification of the exact location and cause of the problem
• Formulation of effective treatment plans
• Reduction in aspiration risk and subsequent respiratory issues

Recovery:

• Minimal downtime; most patients can resume normal activities immediately.
• Temporary sore throat or nasal passage discomfort may occur.
• Follow-up appointments to discuss results and treatment plans.

Alternatives:

• Modified Barium Swallow Study (MBSS)
• Clinical (bedside) swallowing evaluation ######## Comparisons:
• MBSS involves X-ray and fluoroscopy, which exposes the patient to radiation but provides a detailed structural view.
• Clinical evaluations offer a non-invasive approach but may lack the detailed sensory assessment provided by FEES.

Patient Experience:

• Patients may feel mild discomfort during the insertion of the endoscope.
• The test may induce coughing or gagging but is generally well-tolerated.
• Pain is usually minimal and easily managed with the topical anesthetic.