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Flexible Endoscopic Evaluation of Swallowing with Sensory Testing


Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), or laryngopharyngeal sensory testing, is a technique used to directly examine motor and sensory functions of swallowing so that proper treatment can be given to patients with swallowing difficulties to decrease their risk of aspiration (food and liquids going into the lungs instead of the stomach) and choking. FEESST was invented by Dr. Jonathan E. Aviv MD, FACS in 1993, and has been used by otolaryngologists (ear, nose and throat doctors), pulmonologists (lung doctors), gastroenterologists (stomach and digestion doctors), intensivists (intensive care specialists) and speech-language pathologists for the past 20 years.

Swallowing consists of two distinct but interrelated processes: 1. Moving food and liquids from the mouth into the stomach through a set of coordinated muscle movements of the mouth larynx, pharynx and the esophagus 2. Protecting the airway to prevent food and liquids from entering the lungs. This natural process of swallowing can be disrupted in many ways. The problem can occur when the movements involved in swallowing are restricted due to a tumor, any type of blockage, or paralysis after a stroke. Besides the motor problems, swallowing can be impaired due to sensory dysfunction, meaning when sensation (the ability to feel) is lost or reduced anywhere in the throat area. The loss of sensation can be caused by a problem originating in the brain, such as what happens after certain types of stroke, or it can be a result of a nerve injury or swelling in the actual throat area.

FEESST is the only test currently available which can identify if there is any loss of sensation in the throat area. Before FEESST was invented, all tests of swallowing, be they X-ray based tests (Modified Barium Swallow (MBS) or endoscopy-based tests (Fiberoptic Endoscopic Evaluation of Swallowing (FEES) solely looked at the motor component of swallowing without examining the sensory aspect of a swallow or the ability to feel.

FEESST is an outpatient procedure involving the passing of a thin flexible scope through the nose to the pharynx. The exam consisting of two parts. First part assesses sensation in the pharynx and airway protection. The airway protection is assessed by sending air-pulses to the throat area that is innervated by the vagus nerve, which is the region of the throat between the top of the vocal folds to the tip of the epiglottis in order to stimulate an airway protective reflex called the laryngeal adductor reflex (LAR). This reflex, which occurs when the tissues of the throat are stimulated, causes the vocal folds to close in order to protect the airway from food going into the lungs. Since the windpipe (trachea) is located so close to the food-pipe (esophagus) this is a critical reflex to be functioning well at all times. Stimulation of this reflex not only results in protection of the airway, it also initiates a swallow. When a swallow is initiated the larynx rises up to two inches, going further away from the esophagus, thereby acting as an additional cover for the airway.


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