title: Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue-dyed food.
abstract: The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech-language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61-1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA. steven.leder@yale.edu
authors.forename: Steven B
authors.initials: SB
authors.lastname: Leder
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Acton
authors.forename: Heather L
authors.initials: HL
authors.lastname: Lisitano
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001557:Benzenesulfonates; D004396:Coloring Agents; D003680:Deglutition Disorders / Q000175:diagnosis*; D004945:Esophagoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D001557:Benzenesulfonates; D004396:Coloring Agents; C006796:brilliant blue