Question
I am aware of an ENT in my area (CA) who performs FEEST in her office without a speech pathologist. We subsequently did a VFSS on one of her patients for whom she recommended a supraglottic swallow based on her exam, and determined that the supraglottic w
Answer
Your question has raised several questions in my mind which I will touch on briefly. First, you ask whether it is possible to determine whether the supraglottic swallow (SGS) works with a FEES examination because "there is no visualization during white out" This is not entirely true - you do visualize the time just prior to and at the onset of the swallow, when most of the structural movements begin. In the case of the SGS, you would directly see whether the patient was able to close off the glottis with a volitional breath hold. If the patient did not achieve complete closure, you have your answer. If the patient did achieve complete closure but did not sustain it during the swallow, you would see evidence of aspiration after the view returned (after white-out). If you use barium-tinged liquid, especially if it is dyed blue or green, you will see a coating of barium in the laryngeal vestibule, on the vocal folds, or below the vocal folds if there was aspiration.
Otolaryngologists are certainly able to perform FEES, since physicians can perform virtually any procedure that we do, according to their scope of practice, or to supervise them. This does not assure that they are knowledgeable about the procedure or its findings. An institution may set its own requirements or standards for a discipline to be able to perform a procedure that would restrict its use within that setting, but this rarely applies to swallowing evaluation and therapy and physicians.
As with any quandary, the best solution is probably to talk to the ENT sometime, face to face, and get to know her/his interests and expertise. Perhaps you can collaborate and do the exam together - you will likely both learn from this partnership.
Susan Langmore, Ph.D., BRS-S, is currently a Professor in the department of Otolaryngology, Boston University Medical Center and Department of Communication Disorders, Boston University. She has clinical experience with all types and settings of patients with dysphagia. Current PI of NIH grant investigating exercise and e-stim treatment for post-radiated head and neck cancer patients with dysphagia. Developed FEES; first published on FEES in 1988.
