Table 1 Contents of the basic workshop
A) Basics |
• History of FEES |
• Aims of the evaluation |
• Indications |
• Contraindications |
• Limits |
• Examination procedure |
• Distribution of tasks and responsibilities within the examination team |
• Alternative instrumental dysphagia assessments and their indications |
○ Videofluoroscopic swallow study |
○ Pharyngeal and oesophageal manometry |
B) Diseases |
• Neurovascular diseases (e.g. ischaemic stroke) |
• Neurodegenerative diseases (e.g. Parkinson’s disease, dementia) |
• Neuromuscular diseases (e.g. ALS, polymyositis) |
• Neurotraumatology (e.g. traumatic brain injury) |
• Neuro-oncological diseases (e.g. gliomas, paraneoplastic diseases) |
• Neuroinfectious diseases (e.g. brainstem encephalitis) |
• Age-related changes in the swallowing mechanism (presbyphagia) |
• Differential diagnosis of neurogenic dysphagia (e.g. cervical spine surgery, Morbus Forestier, disobliteration of the internal carotid artery, laryngeal reflux, Zenker’s diverticulum) |
C) Equipment |
• Flexible endoscope |
○ Fibre endoscope |
○ Video endoscope |
• Light source |
• Video camera |
• Processing software |
• Consumables |
• Hygiene and cleansing |
D) Preparations |
• Patient information |
• Patient positioning |
• Local anaesthesia |
• Nasal decongestant |
• Defogging |
• Emergency management |
E) Endoscope handling and placement |
• Holding and operating the endoscope |
• Nasal passage |
• Velum |
• Oropharynx/hypopharynx and larynx |
○ Home position |
○ Close view |
F) Standard FEES protocol |
• Anatomic observation |
○ Stenosis of the nasal meatus |
○ Velopharyngeal incompetence |
○ Pharyngeal stenosis (post radiation) |
○ Post-operative findings |
○ Mucosal abnormalities |
○ Oedema |
○ Signs of gastro-oesophageal reflux |
○ Irregular position of gastric tube |
○ Saliva pooling |
○ Abnormal position of epiglottis, arytenoid cartilage and glottis |
• Physiological examination |
○ Velopharyngeal closure |
○ Movement of the base of the tongue |
○ Epiglottis inversion |
○ Pharyngeal wall contraction |
○ Vocal cord and vestibular fold movement |
○ Sensory functions |
• Evaluation of swallowing |
○ Choice of consistency depending on the problem at hand |
○ ‘White-out’ characterisation and post-swallow stage |
○ Identification of the salient findings |
– Oral bolus control, leaking |
– Delayed swallowing reflex |
– Residues |
– Penetration |
– Aspiration |
– Temporal characteristics of penetration and aspiration (predeglutitive, intradeglutitive or postdeglutitive) |
– Adequacy of clearance effort |
○ Identification of the main pathomechanisms |
• Evaluation of different therapeutic manoeuvres |
• Evaluation and interpretation of the examination |
○ Classification |
○ Degrees of severity |
○ Therapeutic consequences (e.g. nutrition management, rehabilitation) |
• Indications for referral to further medical departments (e.g. otolaryngology, enterology, phoniatrics) |
G) Neurological examination protocols |
• FEES protocol for stroke patients |
• FEES tensilon test |
• Fatigable swallowing test |
• FEES L-dopa test |
• Decannulation protocol |