Bedside clinical swallow exams by SLPs have proven to be under-estimating and over-estimating aspiration; therefore, the use of instrumental swallow evaluations is imperative.
There are certain risk factors in the SNF population that are predictors of aspiration pneumonia.
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Evidence of aspiration/penetration after the swallow, and how fatigue can impact swallow function can be appreciated to a greater level on FEES because the recording lasts longer than the MBSS.
The direct visualization, in color, of anatomy during FEES allows for assessment of tissue/muscle function and anatomical variants, providing insight into the true etiology for the dysphagia.
FEES has proven to be a good assessment of vocal cord function and saliva management, high risk factors associated with aspiration pneumonia.
FEES allows the clinician to observe the transition from breathing to apnea during swallowing.
Aspiration occurs about 25% of the time BEFORE the swallow, about 10% DURING the swallow, and about 65% AFTER the swallow.
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Of the potential risks associated with endoscopy, including gagging, epistaxis, laryngospasm, and vasovagal response; a mild case of epistaxis is the most prevalent.
The rate of complications associated with FEES is less than 1% overall.
FEES has proven to be a safe and well tolerated method of assessing swallow function when performed by a trained Speech Language Pathologist.
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Studies show that endoscope placement does not adversely affect swallow function.
When trained, experienced SLPs perform FEES, the incidence of complications and pt intolerance is minimal.
Low levels of lidocaine can enhance exam tolerability without negatively impacting swallow scores.
Higher levels of topical anesthesia or vasoconstrictors may lead to an increase in penetration/aspiration scores.
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