Global InformationFlexible Endoscopic Evaluation of Swallowing with Sensory Testing information
Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), or laryngopharyngeal sensory testing, is a technique used to directly examine motor and sensory functions of swallowing so that proper treatment can be given to patients with swallowing difficulties to decrease their risk of aspiration (food and liquids going into the lungs instead of the stomach) and choking. FEESST was invented by Dr. Jonathan E. Aviv MD, FACS in 1993,[1] and has been used by otolaryngologists (ear, nose and throat doctors),[2] pulmonologists (lung doctors),[3] gastroenterologists (stomach and digestion doctors),[4] intensivists (intensive care specialists)[5] and speech-language pathologists [6] for the past 20 years.
Swallowing consists of two distinct but interrelated processes: 1. Moving food and liquids from the mouth into the stomach through a set of coordinated muscle movements of the mouth larynx, pharynx and the esophagus 2. Protecting the airway to prevent food and liquids from entering the lungs.[7] This natural process of swallowing can be disrupted in many ways. The problem can occur when the movements involved in swallowing are restricted due to a tumor, any type of blockage, or paralysis after a stroke. Besides the motor problems, swallowing can be impaired due to sensory dysfunction, meaning when sensation (the ability to feel) is lost or reduced anywhere in the throat area. The loss of sensation can be caused by a problem originating in the brain, such as what happens after certain types of stroke, or it can be a result of a nerve injury or swelling in the actual throat area.
FEESST is the only test currently available which can identify if there is any loss of sensation in the throat area. Before FEESST was invented, all tests of swallowing, be they X-ray based tests (Modified Barium Swallow (MBS)[8] or endoscopy-based tests (Fiberoptic Endoscopic Evaluation of Swallowing (FEES)[9][10] solely looked at the motor component of swallowing without examining the sensory aspect of a swallow or the ability to feel.
- ^ Aviv JE, Martin JH, Keen MS, Debell M, Blitzer A. Air-pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol 1993; 102: 777-780.
- ^ Ulualp S Brown A, Sanghavi R, Rivera-Sanchez Y. Assessment of laryngopharyngeal sensation in children with dysphagia. Laryngoscope. 2013 Sep;123(9):2291-5.
- ^ Phua SY, McGarvey LPA, Ngu MC, Ing AJ. Patients with gastro-oesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity Thorax 2005; 60:488-491.
- ^ Aviv JE, Johnson LF. Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) to diagnose and manage patients with pharyngeal dysphagia. Practical Gastro 2000; 24: 52-59.
- ^ Clayton NA, Carnaby-Mann GD, Peters MJ, Ing AJ. The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity. Ear Nose Throat J. 2012 Sep;91(9):370-382.
- ^ Setzen M, Cohen MA, Mattucci KF, Perlman PW, Ditkoff MK. Laryngopharyngeal sensory deficits as a predictor of aspiration. Oto Head Neck Surg 2001; 124: 622-624.
- ^ Zamir Z, Ren J, Hogan W, Shaker R. Coordination of deglutitive vocal cord closure and oral-pharyngeal swallowing events in the elderly. European J Gastro Hepatol 1996; 8: 425-429.
- ^ Brady S, Donzelli J. The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol Clin North Am. 2013 Dec;46(6):1009-22
- ^ Logemann, J. Role of the Modified Barium Swallow in Management of Patients with Dysphagia. Otolaryngol Head Neck Surg 1997;116: 335-338.
- ^ Bastian RW. Videoendoscopic evaluation of patients with dysphagia: An adjunct to modified barium swallow. Otolaryngol Head Neck Surg 1991; 104: 339-350.