title: Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy.
abstract: OBJECTIVE
  The objective of this study was to compare the results of videofluoroscopy (VFS) with flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in dysphagia testing.
  
  
  METHODS
  The authors conducted a retrospective review of data collected over a 4-year period at a tertiary care medical center. The FEESST and VFS results for patients receiving both examinations within a 2-week period were compared with respect to swallowing function. Comparisons were categorized as full agreement, minor disagreement that would not result in a significant difference in diet recommendations, and major disagreement that would result in a significant difference in diet recommendations. Kappa with quadratic weighting was calculated to evaluate the inter-test agreement.
  
  
  RESULTS
  Fifty-four patients met inclusion criteria and were reviewed. Forty-one percent of patients were not eating by mouth at the time of FEESST and the mean interval between the two examinations was 5 days. Laryngeal examination revealed edema/erythema in 93%, impaired pharyngeal squeeze in 66%, decreased laryngopharyngeal sensation in 82%, and absent laryngeal adductor reflex in 30%. FEESST with all consistencies revealed pooling in 89%, penetration in 83%, and aspiration in 65% of patients. VFS revealed pooling in 65%, penetration in 67%, and aspiration in 54% of patients. Comparison of FEESST and VFS revealed full agreement in 52%, minor disagreement in 13%, and major disagreement in 35% of patients. A weighted kappa value of 0.324 signified only "fair" agreement between the two tests.
  
  
  CONCLUSIONS
  FEESST and VFS may not represent comparable tests of dysphagia. Further comparative studies of tests of swallowing function are required to determine the ideal approach to dysphagia testing.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, NY 10021, USA. atabaee@hotmail.com
authors.forename: Abtin
authors.initials: A
authors.lastname: Tabaee
authors.forename: Paul E
authors.initials: PE
authors.lastname: Johnson
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Gartner
authors.forename: Kevin
authors.initials: K
authors.lastname: Kalwerisky
authors.forename: Rosemary B
authors.initials: RB
authors.lastname: Desloge
authors.forename: Michael G
authors.initials: MG
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012307:Risk Factors; D012677:Sensation / Q000502:physiology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014741:Video Recording