title: Fibreoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity?
abstract: OBJECTIVE
  The aim of the study was to investigate whether the type of instrumental swallowing examination (Fibreoptic Endoscopic Evaluation of Swallowing (FEES) or videofluoroscopy) influences perception of post-swallow pharyngeal residue.
  
  
  METHODS
  Prospective, single-blind assessment of residue from simultaneous videofluoroscopy and FEES recordings. All raters were blind to participant details, to the pairing of the videofluoroscopy and FEES examinations and to the other raters' scores.
  
  
  METHODS
  Tertiary specialist ENT teaching hospital.
  
  
  METHODS
  Fifteen adult participants consecutively recruited; seven women and eight men aged between 22 and 73, mean age 53. All participants underwent one FEES examination and one videofluoroscopy examination performed simultaneously.
  
  
  METHODS
  referred to speech and language therapy for assessment of dysphagia.
  
  
  METHODS
  nil by mouth or judged to be at high risk of aspiration.
  
  
  METHODS
  The FEES and videofluoroscopy examinations were recorded simultaneously. Fifteen speech and language therapists independently scored pharyngeal residue as none, coating, mild, moderate or severe. All examinations were scored twice by all raters.
  
  
  RESULTS
  Intra- and inter-rater agreement were similar for both examinations. There were significant differences between FEES and videofluoroscopy pharyngeal residue severity scores (anova, P < 0.001). FEES residue scores were consistently higher than videofluoroscopy residue scores.
  
  
  CONCLUSIONS
  Pharyngeal residue was consistently perceived to be greater from FEES than from videofluoroscopy. These findings have significant clinical implications as FEES and videofluoroscopy findings are used to judge aspiration risk and to make recommendations for oral intake. Further research is required to examine the impact of FEES and videofluoroscopy examinations on treatment decisions.
authors.affiliation: Head and Neck Tumour Centre, University College Hospital, London, UK. annette.kelly@uclh.nhs.uk
authors.forename: A M
authors.initials: AM
authors.lastname: Kelly
authors.forename: P
authors.initials: P
authors.lastname: Leslie
authors.forename: T
authors.initials: T
authors.lastname: Beale
authors.forename: C
authors.initials: C
authors.lastname: Payten
authors.forename: M J
authors.initials: MJ
authors.lastname: Drinnan
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001364:Awareness; D015986:Confounding Factors, Epidemiologic; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D016145:Endoscopy, Digestive System; D005260:Female; D005336:Fiber Optic Technology; D005471:Fluoroscopy; D006801:Humans; D007808:Language Therapy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010614:Pharynx / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013070:Speech Therapy; D016896:Treatment Outcome; D014741:Video Recording