Why INSTRUMENTAL Assessment?
In 1983, Dr. Jere Logemann reported the first study using MBS to assess the oral and pharyngeal phases of the swallow. By doing so, she propelled speech-language pathologists to the forefront of dysphagia management and gave us an objective tool for detecting penetration and aspiration. Without an instrumental assessment, studies have shown that the Bedside Swallow Exam has a 70% false positive rate leading to unnecessarily restrictive diets. This practice can lead to malnutrition, dehydration, recurrent UTI's, and electrolyte imbalance. Additionally, the bedside has a 14% false negative rate, potentially not detecting silent aspiration at all. With the prevalence of dysphagia among nursing home residents between 40% and 70%, accurate diagnosis and treatment plans are paramount. And how can we diagnose and treat what we can not see?
In 1988, Susan Langmore first published the use of FEES to detect aspiration and to determine the safety of the swallow and oral feeding. The clinical literature is abundant in its articles comparing FEES and MBS. Most notable is that FEES is more sensitive to detecting penetration, aspiration, pharyngeal residue and assessment of secretion management. Penetration/aspiration scores (using the penetration/aspiration scale) were consistently and significantly higher (more severe) with FEES than with MBS. These studies also stated that FEES is better for evaluating the functions of the pharynx and larynx than MBS. FEES is safe, well tolerated, and can be performed in a variety of settings including the bedside, the treatment room, and mealtime environments. Again, how can we diagnose and treat what we can not see?