Patient-controlled comparison of flexible endoscopic evaluation of swallowing with sensory testing (FEESST) and videofluoroscopy

Objective: The objective of this study was to compare the results of videofluoroscopy (VFS) with flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in dysphagia testing. Methods: The authors conducted a retrospective review of data collected over a 4-year period at a tertiary care medical center. The FEESST and VFS results for patients receiving both examinations within a 2-week period were compared with respect to swallowing function. Comparisons were categorized as full agreement, minor disagreement that would not result in a significant difference in diet recommendations, and major disagreement that would result in a significant difference in diet recommendations. Kappa with quadratic weighting was calculated to evaluate the inter-test agreement. Results: Fifty-four patients met inclusion criteria and were reviewed. Forty-one percent of patients were not eating by mouth at the time of FEESST and the mean interval between the two examinations was 5 days. Laryngeal examination revealed edema/erythema in 93%, impaired pharyngeal squeeze in 66%, decreased laryngopharyngeal. sensation in 82%, and absent laryngeal adductor reflex in 30%. FEESST with all consistencies revealed pooling in 89%, penetration in 83%, and aspiration in 65% of patients. VFS revealed pooling in 65%, penetration in 67%, and aspiration in 54% of patients. Comparison of FEESST and VFS revealed full agreement in 52%, minor disagreement in 13%, and major disagreement in 35% of patients. A weighted kappa value of 0.324 signified only "fair" agreement between the two tests. Conclusions: FEESST and VFS may not represent comparable tests of dysphagia. Further comparative studies of tests of swallowing function are required to determine the ideal approach to dysphagia testing.