Swallow Solutions

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An Overview of Dysphagia

Dysphagia is the term used to describe swallowing difficulties. When someone presents with a swallowing disorder, they may be demonstrating challenges with swallowing certain foods or liquids, while others cannot swallow at all. Signs and symptoms associated with dysphagia include:

  • Pain when swallowing

  • Coughing or throat clearing while eating or drinking

  • Feeling like something is stuck in the throat

  • Food getting "pocketed" in the mouth

  • Difficulty chewing food and initiating a swallow

  • Hoarse or "wet" vocal quality after eating or drinking

  • Avoiding certain foods because of difficulty swallowing them

In some cases, an individual will not show any outward signs of swallowing difficulty, which can lead to aspiration pneumonia and/or weight loss. Clients who have recently been NPO, have advanced neurological conditions or dementia, or have a history of head and neck cancer will benefit from an objective swallow assessment such as FEES to ensure they are not at risk of silent aspiration. 

 
 
What is FEES?

FEES stands for Fiberoptic Endoscopic Evaluation of Swallowing and is performed by a trained speech-language pathologist. FEES uses an endoscope (a small flexible tube with a camera and light on the end) to objectively assess a person's ability to swallow. The endoscope is guided through a patient's nasal passage into the throat so the pharynx and upper esophageal opening can be viewed from above.

 

During the 20-30 minute assessment, the patient will be administered liquids and food mixed with food coloring to view swallow function and anatomy before, during, and after swallowing.

 

The endoscope is connected to a computer with video monitoring so the therapist and patient can view the results in real-time.  

View a FEES assessment below.

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Why Choose FEES?
  • High definition images and video allows the therapist to clearly see the patient's swallow function

  • FEES is conducted where patients have their meals and in the position patients consume food and liquids with no need to transport the patient to radiology or offsite

  • Patients experiencing silent aspiration do not demonstrate outward signs of swallowing dysfunction and are at an increased risk for aspiration pneumonia

  • A study by McCullough et al., 2005, found a 70% error rate in bedside swallowing evaluations leading to inaccurate diet recommendations

  • FEES can be performed in an office, ICU, long-term care facility, or a patient's home in approximately 20 minutes 

  • Patients and family members are able to view aspiration firsthand which has been shown to increase compliance with recommendations

  • ​With no radiation exposure, FEES can be administered for longer time intervals, i.e. during an entire meal, allowing the clinician to assess if a patient's swallowing is affected by fatigue

 
 
How Does FEES® Compare to MBSS/FVSS?
  • Modified Barium Swallow Study (MBSS) or Videofluoroscopic Swallow Study (VFSS) is an x-ray evaluation used to assess swallowing

  • Patients must be transported to the radiology department, decreasing access to medical complex, bedbound, or ventilator-dependent patients, or patients on isolation precautions

  • Patients are required to be in an upright seated position, which may not be the position they typically consume food and/or liquids

  • During a VFSS the x-ray is turned off and on during the evaluation to minimize radiation exposure which hinders the ability to visualize the function immediately before and after the swallow

  • A physician must be present for a MBSS/VFSS 

 
Candidates for FEES®

There are many conditions that can contribute to disordered swallowing. Patients will benefit from an objective swallow assessment to confidently reduce the risk of aspiration pneumonia. We recommend FEES® for patients who are having difficulty swallowing food, liquids, or medications, complaining about something being "stuck" in their throat, have a history of reflux, pain when swallowing, have been NPO, or are experiencing any of the following:

  • Stroke

  • Traumatic Brain Injury

  • Spinal Cord Injury

  • Dementia

  • Alzheimer's Disease

  • Myasthenia Gravis

  • Parkinson’s Disease

  • Multiple Sclerosis

  • ALS

  • Muscular Dystrophy

  • Cerebral Palsy

  • Head and neck cancer

  • COPD

  • GERD

  • Medically complex patients

 FEES® can also be performed on patients who have isolation precautions, are bed-bound, are ventilator dependent, or have feeding tubes. 

Swallowing Therapy Solutions

For any patient experiencing swallowing difficulty, following an evaluation, we will make immediate recommendations related to the types, textures, and thickness of foods and liquids, optimum positioning, and safe swallow strategies. When appropriate, we also offer onsite therapy and have training in the McNeill Dysphagia Therapy Program (MDTP), an exercise-based dysphagia rehabilitation program, and vital stim.

The goal of swallowing therapy is to:

  • Improve the safety and efficiency of the swallow

  • Support adequate nutrition and hydration

  • Maximizing the patient’s quality o

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We Come To You!

Our mobile FEES and videostroboscopy services are offered state-wide!
 
All outpatient therapy services are available throughout Ascension, Livingston, East Baton Rouge, West Baton Rouge, St James, St . John the Baptist, and Assumption parish.