FEEST or Famine…..

You know about FEES….

You’ve more than likely heard about FEES (Flexible Endoscopic Evaluation of Swallowing) by this time.  If not, take a look around this blog because I have been blogging about FEES all month!

But have you heard about FEEST?

Have you heard of FEEST?  Flexible Endoscopic Evaluation of Swallowing with Sensory Testing is another method to evaluate swallowing using instrumentation.

The FEEST exam is performed much like FEES with an endoscope passed transnasally to assess the swallow.   FEEST, however adds an air-pulse stimuli that is delivered to the mucosa innervated by the superior laryngeal nerve to elicit the laryngeal adductor reflex (LAR).

So what is LAR?

“The laryngeal adductor reflex (LAR) is an involuntary protective response to stimuli in the larynx. The superior laryngeal nerve (SLN) acts as the afferent limb and the recurrent laryngeal nerve (RLN) as the efferent limb of this reflex, which is modulated by the central nervous system.”

What can I see with FEEST?

FEEST, not only allows you to evaluate the pharyngeal swallow and the sensory aspect of the larynx and the mucosa innervated by the superior laryngeal nerve, you can also evaluate manifestations of GERD such as Larynopharyngeal Reflux (LPR) which can include sensation of bolus, voice changes or asthma.

What do you think?

Do you think that FEEST may be an appropriate exam for your patients?  What patients are appropriate for FEEST?

References:

Domer, A. S., Kuhn, M. A., & Belafsky, P. C. (2013). Neurophysiology and clinical implications of the laryngeal adductor reflex. Current otorhinolaryngology reports1(3), 178-182.

Rees, C. J. (2006). Flexible endoscopic evaluation of swallowing with sensory testing. Current opinion in otolaryngology & head and neck surgery14(6), 425-430.Thompson, D. M. (2003).

Laryngopharyngeal sensory testing and assessment of airway protection in pediatric patients. The American journal of medicine115(3), 166-168.

O‘Horo, J. C., Rogus‐Pulia, N., Garcia‐Arguello, L., Robbins, J., & Safdar, N. (2015). Bedside diagnosis of dysphagia: a systematic review. Journal of hospital medicine10(4), 256-265.

Kim, T., Goodhart, K., Aviv, J. E., Sacco, R. L., Diamond, B., Kaplan, S., & Close, L. G. (1998). FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing. Annals of Otology, Rhinology & Laryngology107(5), 378-387.

Aviv, J. E., Kaplan, S. T., Thomson, J. E., Spitzer, J., Diamond, B., & Close, L. G. (2000). The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia15(1), 39-44.

Aviv, J. E., Kim, T., Thomson, J. E., Sunshine, S., Kaplan, S., & Close, L. G. (1998). Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls. Dysphagia13(2), 87-92.

http://www.feesst.com/index.php

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