Let’s face it, in our profession we can’t even agree if we should call a swallowing problem dys-fay-gia or dys-fah-gia, so how is it that we should agree on a single instrumental exam?
Well, the answer is we shouldn’t.
We should have both FEES and MBS available for instrumental testing. We should be free to choose the exam that gives the answers to the questions we are asking. If I’m wondering why Mr. Smith is coughing during and after his meals, let’s FEES away…concerns for chronic coughing, secretion management, changes in vocal quality and complaints of globus sensation warrant that. Now if Mrs. Smith is showing me she has food getting stuck in the mediastinal region and she has a history of esophageal difficulties, MBS makes sense. One of my favorite docs breaks it down like this…bigger concerns with liquids, FEES them. Dysphagia to solids? Lean on MBS. I’m not saying it’s black or white…like an MBS. Really, swallowing usually deserves a BRIGHTER, more colorful assessment like the FEES. Consider factors like how quickly testing needs to be completed, if you are concerned for fatigue, if you want to train the patient using biofeedback…then scoping away will make your day. FEES gives you all those advantages!
Looking at the typical SNF roster, 75% of those residents with dysphagia needing an instrumental swallow test would be best serviced with FEES at the bedside in their typical eating position swallowing actual food served from the kitchen, like rice, salad, spaghetti, sandwiches…not barium coated crackers. #FEESadvantage! If we are testing swallow function for a meal, then let’s keep it real! Order up a regular meal from the kitchen and let’s see during the FEES how those cabbage rolls or meatballs actually go down.
Did I mention radiation typically cuts off my view of an MBS at 3 minutes? And that’s if I’m lucky to record that much footage! I mean, that’s like paying MOVIE PRICES to see just a PREVIEW! Well, when it comes to my older patients, I want to know what happens at minute 12, 15, 18, 25…I need to see the impact of fatigue on bolus control and pharyngeal clearance! Again, point to the challenger, FEES. No time limits with FEES, so I can view that entire meal.
I am so thankful that I was taught by open-minded, savvy SLPs in a strong rehab environment with MD support. I’m fortunate that I came into SLP-ing at a time when clinical practice was not as constricted by financial resources as it is today. Back in the day, the only question was “What instrumental study does the patient need?” not “How much will the test cost?” or worse yet “Can’t you just leave them on a modified diet?”
We should always focus on evidenced-based practice and best practices for patient care.
Be sure to take the time and THINK about the test you need based on your therapy goals, questions and concerns…make sure you are getting the best value for your therapy dollars! #FEESadvantage #sdxslps #dysphagianerd