MBSS AND FEES. Why Not Both?

MBSS VS. FEES

Whenever you read the literature, you often see MBSS vs. FEES or a similar thought comparing the two tests, attempting to find the superior, gold standard assessment.

On social media, we seem to have 2 camps.   Team MBSS and Team FEES.   You can’t be friends and in separate camps!!  (Completely joking here!!!)

Many facilities choose one test or the other.   You can either request MBSS or FEES.  They’ll have a contract for Mobile MBSS or Mobile FEES.   In the hospital, it’s either/or.

What would happen if we try to change that thought.   What if, we changed from an either/or to a both.

What If…….

What if companies had the option of both.  Maybe the ability to do both tests at one time?  Even if they are completed at different times.  Both tests give you such a varied viewpoint of the swallow while often providing the same information regarding the swallow.

The literature says……

The majority of the research tells us that we see the same pharyngeal events with FEES that we see with MBSS including decreased back of tongue control/oral containment resulting in premature posterior loss of bolus, decreased hyolaryngeal excursion, decreased epiglottic introversion, decreased laryngeal closure resulting in penetration/aspiration or vallecular residue.   We may see decreased opening of the Pharyngoesophageal Sement (PES)/Upper Esophageal Sphincter (UES)  resulting in pyriform sinus residue and maybe aspiration.  We can see residue on the posterior pharyngeal wall due to decreased pharyngeal squeeze/stripping wave.

So, in fact, with either test we can see the physiological events of the swallow that lead us into a plan of treatment.

Much of the research states that residue, aspiration, etc are all rated as more severe when using FEES.

What about the doctors

Look at physicians.   they will often order a CT scan for a stroke patient.   When this doesn’t give them all the information needed, they often then order an MRI.   The CT and MRI do give different viewpoints and provide some different information and compliment each other very well.

Anecdotal thoughts.

In my experience, not just reading the research, when a patient had a FEES (performed by me) and later had an MBSS (performed by a colleague) the findings were exactly the same leading to identical recommendations.   In fact, I did not know until after the test that the patient was going to have an MBSS and the other SLP did not know until after the test, the results from the FEES.

Changing our thinking.

So let’s work on changing our thinking to BOTH tests, not just one or the other.  Let’s educate other medical professionals that we are looking for much more than just aspiration or penetration and that we can do so much more than just change a diet.

Let’s make a change!

References:

Aviv, J. E. (2000). Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. The Laryngoscope110(4), 563-574.

Schatz, K., Langmore, S. E., & Olson, N. (1991). Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Annals of Otology, Rhinology & Laryngology100(8), 678-681.

Brady, S., & Donzelli, J. (2013). The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngologic Clinics of North America46(6), 1009-1022.

Leder, S. B., Sasaki, C. T., & Burrell, M. I. (1998). Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia13(1), 19-21.

Bastian, R. W. (1991). Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngology—Head and Neck Surgery104(3), 339-350.

Langmore, S. E. (2003). Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?. Current opinion in otolaryngology & head and neck surgery11(6), 485-489.

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