title: Use of fiberoptic endoscopic evaluation of swallowing (FEES) in the management of psychogenic dysphagia in children.
abstract: OBJECTIVE
  To describe the use of fiberoptic endoscopic evaluation of swallowing (FEES) as an adjunct in the management of children presenting with psychogenic dysphagia, defined as food avoidance and excessive fear of eating without identifiable anatomic or functional swallowing abnormalities.
  
  
  METHODS
  Case series of patients presenting to the otolaryngology clinic of a tertiary pediatric teaching hospital between 2007 and 2008 that were evaluated and managed with the utilization of FEES. The outcomes measured were age, gender, duration of symptoms, findings of FEES, additional work-up and resolution of symptoms at follow-up.
  
  
  RESULTS
  Five patients (4 males, 1 female) with ages ranging from 5 to 13 years old (mean=8.6). The median duration of symptoms before presentation was 3 weeks. Four families described refusal of solids starting after choking episode and variable estimated weight loss (mean 2.8kg). One child presented with vague complaints of intermittent odynophagia and food refusal. Fiberoptic endoscopic evaluation of swallowing was performed on all patients. No abnormalities of the oropharyngeal swallow were appreciated. Additional management included different combinations of modified barium swallow study, esophagastroduodenoscopy (EGD), upper GI series, antibiotics, and psychotherapy. Mean follow-up with clinic visit was 4.2 months. Three of the five children reported complete resolution of symptoms after FEES at follow-up visit.
  
  
  CONCLUSIONS
  Fiberoptic endoscopic evaluation of swallowing can be a useful management tool in children with psychogenic dysphagia as it provides direct visualization of the oropharyngeal swallowing mechanism. This can be used to provide visual reassure and biofeedback to patients and parents. Additional workup should be decided on an individual basis.
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Pediatric Otolaryngology, United States.
authors.forename: Prasad John
authors.initials: PJ
authors.lastname: Thottam
authors.affiliation: University of Florida, Division of Pediatric Otolaryngology, United States.
authors.forename: Rodrigo C
authors.initials: RC
authors.lastname: Silva
authors.affiliation: The University of Tennessee, Division of Pediatric Otolaryngology, United States.
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: McLevy
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Pediatric Otolaryngology, United States.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Simons
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Department of Pediatric Otolaryngology, United States. Electronic address: Deepak.mehta@chp.edu.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology* / Q000523:psychology* / Q000628:therapy; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D055100:Optical Fibers; D010698:Phobic Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy
keywords: Dysphagia; Fiberoptic endoscopic evaluation of swallowing (FEES); Pediatrics; Phagophobia; Pyschogenic dysphagia