Impact of Fiberoptic Endoscopic Evaluation of Swallowing Outcomes and Dysphagia Management in Neurodegenerative Diseases
Editor's Note: This Manuscript was accepted for publication on May 13, 2020.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Abstract accepted for oral presentation at American Broncho-Esophagological Association Meeting, Atlanta, Georgia, U.S.A., April 22–24, 2020 (conference canceled due to COVID-19).
Abstract
Objectives/Hypothesis
To determine the incidence of abnormal fiberoptic endoscopic evaluation of swallowing (FEES) findings in patients with progressive neurologic disorders and identify the most commonly implemented dysphagia management strategies.
Study Design
Retrospective Review.
Methods
A retrospective review was performed of patients with neurodegenerative disease who underwent FEES at a tertiary-care center between 2008 and 2019. Patient demographics, diagnosis, and Eating Assessment Tool-10 (EAT-10) scores were recorded. Rates of penetration, aspiration, and functional change in management (FCIM) to include dietary modifications, home exercises, swallow therapy, surgical intervention (injection augmentation or esophageal dilation), or alternative means of nutrition (i.e., percutaneous enteral gastrostomy [PEG] tube) were calculated.
Results
Two hundred nine FEES assessments were performed in 178 patients with a mean age of 64.8 years (standard deviation = ±14). The most common diagnoses were amyotrophic lateral sclerosis (32%) followed by Parkinson's disease or Parkinsonism (26%). FEES demonstrated penetration in 72.5% of patients and aspiration in 14.6%. Mean EAT-10 scores differed between patients with aspiration versus penetration versus normal FEES (24.7 vs. 14.9 vs. 13.9, respectively, P < .001). An FCIM was recommended in 88% of patients and most commonly included self-directed modifications (43%). Overall, 4.5% of patients underwent surgical intervention. A PEG tube was recommended for either supplemental or sole form of nutrition in 19% of the entire cohort.
Conclusions
Most patients with neurodegenerative diseases presenting with dysphagia demonstrated abnormal FEES findings necessitating an FCIM, suggesting early dysphagia evaluation may be warranted in this cohort. These findings correlate with worsened EAT-10 scores in patients with aspiration or penetration on FEES.
Level of Evidence
4 Laryngoscope, 131:726–730, 2021
