Flexible Endoscopic Evaluation of Swallowing (F.E.E.S.)
WHAT IS F.E.E.S. AND WHO WILL DO THIS TEST?
We are able to quickly and easily assess swallowing in our office without the use of
radiation or barium. We place a flexible endoscope into the nostril and
advance the scope to the oropharynx. We are able to view the base of
tongue, vallecular and pyriform sinuses, epiglottis, arytenoids, and vocal
cords. Although we are unable to see the laryngeal structures during the
split second of "white-out" (when laryngeal structures close around the camera)
we can see pooling and stasis of bolus in vallecula, pyriform, and laryngeal
vestibule. If food or liquid is evident on or below the vocal cords, we know the
patient is at risk for aspiration. A color video is immediately shown to
the patient for education purposes. A written report is sent to the referring
physician. This test is performed by a speech pathologist who has
completed specialized training.
WHY DO I NEED THIS TEST?
To assess laryngeal structure and function during swallowing. The pictures are large and
clear. The physician and speech pathologist use this information for
diagnosis and treatment of your medical condition. This test is typically
ordered if the patient reports coughing, choking, feels a lump in throat, or
feels something sticking in throat.
HOW LONG WILL THIS TAKE?
The entire procedure should take about 30 minutes but the camera will be placed in your nose for
approximately 5 minutes.
HOW DO I PREPARE?
There is no preparation--you DO NOT need to withhold any food, liquid,
or medication prior to this test.
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Videostroboscopy
WHAT IS VIDEOSTROBOSCOPY AND WHO WILL DO THIS TEST? It involves the use of an endoscope,
which is a rigid tube that is slightly thicker than a pencil. The endoscope is placed in
your mouth but does not go down your throat. A bright light at the tip of the endoscope shines
down your throat and a camera projects the image onto a computer screen. A speech pathologist
who has undergone extensive training will perform the test.
WHY DO I NEED THIS TEST? Laryngeal videostroboscopy (videostrobe) provides a
powerful and convenient means of examining laryngeal anatomy and vocal fold physiology. Numerous
articles in the professional literature have validated the advantages of stroboscopy over
traditional viewing techniques for diagnosing patients with vocal symptoms and, in many cases, the technique
has been indispensable for correct diagnosis (e.g., Woo et al., Journal of Voice, vol. 5 (3), 1991. pp. 231-238).
Using stroboscopy, laryngeal disease can be detected earlier, functional disorders can be diagnosed with
greater accuracy and patient performance can be documented clearly before and after surgery, voice rehabilitation
or drug administration. The video is immediately shown to the patient for educational purposes.
A written report and photo are sent to the referring physician.
HOW LONG WILL THIS TAKE? The entire procedure should take about 30 minutes but the endoscope
will only be in your mouth about 5 minutes. If you are scheduled for a voice evaluation as well, you
should allow about 1 hour if your doctor ordered both tests.
HOW DO I PREPARE? There is no preparation for this test. You DO NOT need to withhold
food or liquid prior to the test.
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Modified Barium Swallow
A Modified Barium Swallow Study, administered by a speech-language pathologist, is an x-ray designed to assess the safety of different food and liquid consistencies passing through the oral and pharyngeal cavity in Real-Time during the swallow. The results help determine the safest foods/liquids that the patient can consume orally, as well as appropriate exercises to be utilized in therapy.
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Swallowing Disorders
By medical standards, Dysphagia is defined as the inability or swallow and/or difficulty in the ability to swallow effectively without interruption. Depending on your symptoms, a Modified Barium Swallow Study or a Flexible Endoscopic Evaluation of Swallow with Sensory Test can be used to evaluate the cause of a patients' swallowing difficulties.
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Articulation Disorders
Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns). A speech-language pathologist can assess the process by which sounds, syllables and words are formed when your tongue, jaw, teeth, lips, and palate alter the airstream coming from the vocal folds. By 18 months, a child's speech is normally 25% intelligible, by 24 months, a child's speech is normally 50-75% intelligible, and by 36 months, 75 -100% to caregivers. If you are unsure about your child's speech development, discuss it with your physician. Source: Lynch, J.I., Brookshire, B.L., and Fox, D.R. (1980). A Parent - Child Cleft Palate Curriculum: Developing Speech and Language. CC Publications, Oregon. Page 102.
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Language Disorders
Developmental expressive language disorder is a condition in which a child has lower than normal ability in vocabulary, producing complex sentences, and remembering words. However, children with this disorder may have the normal language skills needed to understand verbal or written communication. Receptive language disorders involve the processing of linguistic information. Problems that may be experienced can involve grammar (syntax and/or morphology), semantics (meaning), or other aspects of language.
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Myofunctional Disorders
The prefix "myo" stands for muscle. Orofacial Myofunctional Disorders (OMD) is often commonly referred to as "tongue thrust" because the tongue functions against or between the front or side teeth during swallowing rathering than lifting up into the palate (roof of the mouth). This disorder is generally accompanied by inappropriate function of the muscles of the tongue, lips, jaw, and face. There is frequently a low forward resting posture of the tongue and open lips. The basic problem is related to abnormal orofacial functions and postures. Just as the controlled forces of orthodontic appliances (braces) can move teeth, the abnormal functions and postures related to OMD can influence the development of dental malocclusion (incorrectly positioned teeth, an improper bite relationship between the teeth in the upper and lower arches, or a malformation of the bone of the dental arches). During the act of swallowing, the tongue is thrust against and/or between the teeth. This is called a tongue thrust swallow.
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