Swallowing Evaluation & Management

SLP Endoscopix offers both clinical and endoscopic evaluations of swallowing to adults with dysphagia (swallowing difficulties). Common symptoms of dysphagia include: sensation of food stuck in the throat, throat clearing, coughing, voice changes after swallowing and food coming back up (regurgitation).

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In some cases, dysphagia may cause weight loss, dehydration, malnutrition, aspiration pneumonia (food/liquid entering the airway, causing bacteria to be introduced to the lungs), and choking (food blocking the airway). Given these potential outcomes, and the social-emotional importance of being able to eat, drink and enjoy a meal with friends and family, it is imperative that dysphagia symptoms be managed and rehabilitated when possible.

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How SLP Endoscopix can help me or my patient?

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We are able to evaluate swallow function and determine what type of maneuvers, strategies, exercises and/or modification to consistencies of food and liquid will be beneficial. We can facilitate referrals to relevant medical practitioners, to ensure applicable diagnoses are identified and addressed.

 

How is a swallowing evaluation completed?

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Clinical Evaluation:

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Each swallowing assessment begins with a clinical evaluation completed by a Speech-Language Pathologist (SLP). This involves: 1) obtaining an interview and case history, 2) reviewing medical/clinical records (including the potential impact of medications), 3) an oral-motor examination to evaluate structures and functions required for swallowing, and 4) assessment of swallowing involving solid and liquid trials. The latter will allow the SLP to evaluate swallow safety, and trial modifications to consistency, which may be beneficial.

  

Based on the outcome of the assessment, the SLP will provide recommendations for improving swallowing safety or determine the potential need for additional instrumental evaluation (i.e. Fiberoptic Endoscopic Evaluation of Swallowing or Videofluoroscopy). Additionally, the SLP may recommend a referral to another specialist (e.g. follow up with an ENT, gastroenterologist or pulmonologist) to support the patient’s care, and will ensure referral and collaboration with a dietitian, as required. 

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Instrumental Evaluation:

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If the clinical evaluation suggests that Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is required to better evaluate, manage or rehabilitate the swallow, we can provide this evaluation to our patients quickly, in a clinic environment!

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The FEES procedure for swallowing evaluation/biofeedback, is a safe and effective instrumental assessment of swallowing, which may be completed in office by a trained speech-language pathologist (SLP), in conjunction with an otolaryngologist (ENT), as required. It is a state of the art evaluation which involves the use of a portable fiberoptic endoscopic camera, with light source. A scope is passed along the floor of the nose, so that the larynx (voice box) and surrounding structures, may be viewed. Food coloring is mixed with various consistencies of food and liquid, for the patient to consume, while the camera records the swallow. This test is utilized to determine problems and possible solutions for safe swallowing and aims to limit incidences of aspiration pneumonia.

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Who is appropriate for FEES?  

Individuals with:

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• Pharyngeal dysphagia who require instrumental evaluation to guide management/treatment

• Increased difficulty swallowing over the course of a meal

• Difficulty swallowing saliva/oral secretions, or nasal regurgitation

• Coughing or change in vocal quality associated with eating

• Unexplained recurrent respiratory infections

• Severe dysphagia requiring a conservative evaluation of the swallow

• Previously completed videofluoroscopy (VFSS) who require endoscopy to monitor progress or re-evaluate swallow function

• Would benefit from biofeedback and/or rehabilitation

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When to refer for Fiberoptic Endoscopic Evaluation of Swallowing (FEES) vs. Videofluoroscopy (VFSS, a radiographic test completed in hospital):