Name of the Procedure:

Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; interpretation and report only (FEESST).

Summary

FEESST is a non-invasive procedure that uses a flexible endoscope equipped with a camera to evaluate a patient's ability to swallow and to assess the sensory function of the larynx. The entire procedure is video-recorded to allow for thorough interpretation and reporting.

Purpose

The procedure is primarily used to diagnose swallowing disorders (dysphagia) and to evaluate the sensory function of the laryngeal area. The goal is to identify the cause of swallowing difficulties and to develop an appropriate treatment plan.

Indications

• Difficulty swallowing (dysphagia)
• Chronic coughing or choking while eating or drinking
• Unexplained weight loss
• Recurrent pneumonia
• Voice changes or hoarseness

Preparation

• The patient may be required to fast for a few hours before the procedure.
• Pre-procedure assessment may include a review of the patient's medical history and a physical examination of the throat and neck.

Procedure Description

1. The patient is seated in an upright position.
2. A topical anesthetic may be applied to the nasal passages to minimize discomfort.
3. A flexible endoscope is gently inserted through the nose and advanced to the throat.
4. The healthcare provider observes the swallowing mechanism and sensory response of the larynx while the patient performs specific swallowing tasks.
5. The procedure is recorded on video for detailed analysis.

Duration

The procedure typically takes about 20 to 30 minutes.

Setting

FEESST is usually performed in a hospital, outpatient clinic, or specialized medical office.

Personnel

• Otolaryngologist or speech-language pathologist
• Nursing staff or medical assistant

Risks and Complications

• Mild discomfort or gagging during the procedure
• Minimal risk of nosebleed or irritation of the nasal passages
• Rare risk of laryngospasm (spasm of the vocal cords)

Benefits

• Accurate diagnosis of swallowing disorders
• Specific and individualized treatment planning
• Immediate and real-time visual feedback during the procedure

Recovery

• Most patients can resume normal activities immediately after the procedure.
• Patients may experience slight nasal discomfort or mild throat soreness, which usually resolves quickly.

Alternatives

• Modified Barium Swallow Study (MBSS): Involves X-ray imaging to observe swallowing.
• Video fluoroscopic swallowing study (VFSS): Uses real-time X-ray film to evaluate swallowing.
• Each alternative has its own advantages, such as less discomfort with MBSS but greater exposure to radiation.

Patient Experience

• Patients may feel mild discomfort or gagging as the endoscope is inserted.
• The procedure is generally well-tolerated with minimal pain.
• Following the procedure, patients may experience slight nasal or throat irritation, but this is temporary and usually resolves within a few hours.