Use of fluorescein to improve the sensitivity of flexible endoscopic evaluation of swallowing
Authors:
Lucie Zeinerová 1; Michal Černý 1,2; Michal Homoláč 1,2; Lukáš Školoudík 1,2; Jana Šatanková 1,2; Viktor Chrobok 1,2
Authors‘ workplace:
Klinika otorinolaryngologie a chirurgie hlavy a krku, FN Hradec Králové
1; Univerzita Karlova, LF v Hradci Králové
2
Published in:
Otorinolaryngol Foniatr, 72, 2023, No. 3, pp. 127-135.
Category:
Original Article
doi:
https://doi.org/10.48095/ccorl2023127
Overview
Background: Flexible endoscopic evaluation of swallowing (FEES) is one of the basic methods for objective diagnostics of swallowing disorders. The principle is to swallow boluses of various consistencies under endoscopic control. According to available data and our experience, the quality and accuracy of the examination depends on the visibility of the tested bolus. Aim of the study: Verify that the use of fluorescein improves the sensitivity of the FEES compared to a standard food colouring. Methods: In the study, we performed FEES on 40 patients using green food colouring and fluorescein dyed water. The presence of pre-deglutive leak, bolus stagnation in the pharynx (valleculas, pharyngeal walls, piriform sinuses), bolus penetration into the airways based on the Rosenbek Penetration-Aspiration Scale (PAS), tendency to penetrate through the posterior commissure and subjective comparison of both methods in parameters mentioned above were evaluated. Results: The results show a statistically significantly higher detection of bolus stagnation on the pharyngeal walls (P <0.001) and in the epiglottic valleculas (P = 0.038) with fluorescein-dyed water. When assessing airway bolus penetration, the reliability value reached statistical significance (k = 0.438; P <0.001) between the tested methods (green food colouring vs. fluorescein), which indicates good sensitivity of both methods. However, on the Rosenbek score scale (1–8 points), the methods differed statistically significantly in the assessment of penetration/ aspiration severity (P = 0.001). A statistically significantly greater depth of airway penetration was detected with fluorescein (PAS 3.13) compared to green food colouring (PAS 2.10) (P = 0.001). In a subjective comparison of both methods by the examining physician, the visibility of fluorescein is statistically significantly better in all evaluated parameters. Conclusions: The study showed a better sensitivity of FEES when using fluorescein compared to conventional food colouring. Fluorescein appears to be a good colouring for diagnostics of swallowing disorders.
Keywords:
FEES – flexible endoscopic evaluation of swallowing – fluorescein – bolus staining
Sources
1. Tedla M, Černý M. Poruchy polykání. Havlíčkův Brod: Tobiáš 2018.
2. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration scale. Dysphagia 1996; 11(2): 93–98. Doi: 10.1007/ BF00417897.
3. Langmore SE, Kenneth SMA, Olsen N. Fiberoptic endoscopic examination of swallowing safety: A new procedure. Dysphagia 1988; 2(4): 216–219. Doi: 10.1007/ BF02414429.
4. Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia 2017; 32(1): 27–38. Doi: 10.1007/ s00455-016-9775-x.
5. Bastian RW. Videoendoscopic Evaluation of Patients with Dysphagia: An Adjunct to the Modified Barium Swallow. Otolaryngol Head Neck Surg 1991; 104(3): 339–350. Doi: 10.1177/ 019459989110400309.
6. Černý M, Kotulek M, Chrobok V. FEES – flexibilní endoskopické vyšetření polykání. Endoskopie 2011; 20(2): 70–75.
7. Černý M, Levová H, Michálek R et al. Výživa u pacientů s nádory hlavy a krku. Otorinolaryngol Foniatr 2013; 62(1): 5–13.
8. Hiss SG, Postma GN. Fiberoptic Endoscopic Evaluation of Swallowing. Laryngoscope 2003; 113(8): 1386–1393. Doi: 10.1097/ 00005537- 200308000-00023.
9. Roubíčková L, Košlabová E, Kysílko M et al. Diagnosticka a základy principů terapie dysfagie u pacientů po resekcích nádorů orofaryngeální oblasti. Rehabil fyz Lék 2015; 22(2): 64–69.
10. Baijens LWJ, Walshe M, Aaltonen LM et al. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278(2): 577–616. Doi: 10.1007/ s00405-020-06507-5.
11. Zeinerová L, Černý M, Dědková J. Příručka pro praxi: Videofluoroskopie polykání. Praha: Česká společnost otorinolaryngologie a chirurgie hlavy a krku 2020.
12. Langmore SE. Endoscopic Evaluation and Treatment of Swallowing Disorders. New York: Thieme 2001.
13. Schindler A, Baijens LWJ, Geneid A et al. Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES. Eur Arch Otorhinolaryngol 2022; 279(6): 2727–2742. Doi: 10.1007/ s00405-021-071 61-1.
14. Nienstedt JC, Müller F, Nießen A et al. Narrow Band Imaging Enhances the Detection Rate of Penetration and Aspiration in FEES. Dysphagia 2017; 32(3): 443–448. Doi: 10.1007/ s004 55-017-9784-4.
15. Leder SB, Acton LM, Lisitano HL et al. Fiberoptic endoscopic evaluation of swallowing (FEES) with and without blue-dyed food. Dysphagia 2005; 20(2): 157–162. Doi: 10.1007/ s00 455-005-0009-x.
16. Marvin S, Gustafson S, Thibeault S. Detecting Aspiration and Penetration Using FEES With and Without Food Dye. Dysphagia 2016; 31(4): 498–504. Doi: 10.1007/ s00455-016-9703-0.
17. Jolly K, Gupta KK, Muzaffar J et al. The efficacy and safety of intrathecal fluorescein in endoscopic cerebrospinal fluid leak repair – a systematic review. Auris Nasus Larynx 2022; 49(6): 912–920. Doi: 10.1016/ j.anl.2022.03.014.
18. Bishnoi AK, Garg P, Desai M et al. Fluorescein dye-guided intraoperative identification and closure of muscular ventricular septal defect. World J Pediatr Congenit Heart Surg 2015; 6(1): 59–66. Doi: 10.1177/ 2150135114559292.
19. Hara T, Inami M. Efficacy and safety of fluorescein angiography with orally administered sodium fluorescein. Am J Ophthalmol 1998; 126(4): 560–564. Doi: 10.1016/ s0002-9394(98)00112-3.
20. Barteselli G, Chhablani J, Lee SN et al. Safety and efficacy of oral fluorescein angiography in detecting macular edema in comparison with spectral-domain optical coherence tomography. Retina 2013; 33(8): 1574–1583. Doi: 10.1097/ IAE.0b013e318285cd84.
21. Qaiser D, Sood A, Mishra D et al. Novel use of fluorescein dye in detection of oral dysplasia and oral cancer. Photodiagnosis Photodyn Ther 2020; 31: 101824. Doi: 10.1016/ j.pdpdt. 2020.101824.
22. Aviv JE, Spitzer J, Cohen M et al. Laryngeal Adductor Reflex and Pharyngeal Squeeze as Predictors of Laryngeal Penetration and Aspiration: The Laryngoscope 2002; 112(2): 338–341. Doi: 10.1097/ 00005537-200202000-00025.
23. Murray J, Langmore SE, Ginsberg S et al. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia 1996; 11(2): 99–103. Doi: 10.1007/ BF00417898.
24. de Lima Alvarenga EH, Dall‘Oglio GP, Murano EZ et al. Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol 2018; 275(2): 443–449. Doi: 10.1007/ s00 405-017-4801-7.
Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
Otorhinolaryngology and Phoniatrics
2023 Issue 3
Most read in this issue
- Oesophageal and gastric corrosions – diagnostic and therapeutic approach
- Rhinosinusitis as a complication of FESS: is antibiotic prophylaxis beneficial?
- Follow-up of patients with head and neck tumors: a set of recommendations of the Czech Cooperative Group for Head and Neck Cancer
- Diagnosis of heterotopic gastric mucosa of the upper esophagus and its effect on the laryngeal mucosa