Warnecke et al., 2009 2929 Warnecke T, Ritter MA, Kroger B, Oelenberg S, Teismann I, Heuschmann PU, et al. Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke. Cerebrovasc Dis. 2009;28:283-9.
|
Acute stroke |
153 (80 women) |
Dzeiwas protocol performed by neurologist and speech therapist |
1. Structural evaluation initially with endoscopy |
a. Pasty |
a. Teaspoon of puree |
6-point scale to determine the severity of dysphagia, where 1 = no laryngeal penetration or laryngotracheal aspiration with soft solid (no change) and 6 = penetration or aspiration with saliva (severe) |
b. Liquid |
c. Soft-solid |
b. Teaspoon of water with food contrast |
FEES 24 h after hospital admission |
2. Evaluation of secretion management |
3. Functional evaluation of swallowing |
c. Small piece of white bread |
Note: Quantity and number of offers not specified |
Warnecke et al., 2010 2626 Warnecke T, Oelenberg S, Teismann I, Hamacher C, Lohmann H, Ringelstein EB, et al. Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Mov Disord. 2010;25:1239-45.
|
PSP |
18/11 men |
Levodopa-test; FEES with monitoring by ENT doctor and speech therapist |
1. FEES in the “off” state of levodopa; |
a. Pudding (gelatin) |
a. 3 × 8 mL pudding |
Posteriorleakage of food or liquid; |
PD |
15/11 men |
b. Liquid (water) |
b. 3 × 5 mL liquid |
2. 200 mg dose of levodopa administered |
c. Soft solid (white bread) |
c. 3× pieces of bread (3 cm/3 cm/0.5 cm) |
Penetration and/or aspiration events; |
3. New FEES was performed after 60 min |
Note: All foods colored blue or green |
Presence or absence of waste |
Mandysova et al., 2011 2121 Mandysova P, Skvrňáková J, Ehler E, Cerný M. Development of the brief bedside dysphagia screening test in the Czech Republic. Nurs Health Sci. 2011;13:388-95.
|
Stroke |
87/ND |
Brief Bedside Dysphagia Screening Test
|
1. Physical assessment - motor function of muscles and reflexes involved in swallowing; |
a. Thick liquid |
a. Four teaspoons |
Penetration-aspiration scale by Rosenbek et al. |
MG |
PD |
ALS |
FEES with ENT doctor and nurse monitoring |
b. Thin liquid (spoon) |
b. Four teaspoons |
ENT |
2. Functional assessment of swallowing |
c. Thin liquid (glass) |
c. 60 mL in the glass |
d. Assessment of patient voice after swallowing |
Note: If the patient coughs, chokes, has a wet voice or leaks from the mouth in <1 min, the test was interrupted. |
Note: Not specified if the food was colored during the exams |
D’Ottaviano et al., 20133131 D’Ottaviano FG, Linhares Filho TA, Andrade HM, Alves PC, Rocha MS. Fiberoptic endoscopy evaluation of swallowing in patients with amyotrophic lateral sclerosis. Braz J Otorhinolaryngol. 2013;79:349-53.
|
ALS |
11 (6 men) |
Protocol described in the study, monitored by ENT doctor and speech therapist |
1. Swallowing self-assessment questionnaire |
a. Pasty (water plus two tablespoons of the thickener Resource Thicken Up - Nestlé® |
a. 5 and 10 mL |
Posteriorleakage |
b. 5 and 10 mL |
Food residue |
2. Assessment of tongue mobility and fasciculations |
c. Half of salt and water cracker |
Laryngeal penetration |
Tracheal aspiration |
3. Functional assessment of swallowing |
b. Liquid (water) |
Timing until tracheal aspiration occurs |
c. Solid (cracker) |
Note: All foods colored blue. |
Response to tracheal aspiration |
Pilz et al., 20143636 Pilz W, Baijens LW, Passos VL, Verdonschot R, Wesseling F, Roodenburg N, et al. Swallowing assessment in myotonic dystrophy type 1 using fiberoptic endoscopic evaluation of swallowing (FEES). Neuromuscul Disord. 2014;24:1054-62.
|
DM1 Controls |
45 DM1 (28 men) |
Langmore Protocol22 Langmore S. Endoscopic evaluation and treatment of swallowing disorders. 1st ed. New York: Thieme; 2001. p. 263. Functional Oral Intake Scale (FOIS) Monitored by ENT doctor and speech therapist. |
1. Seated patient |
a. Thin liquid (water) |
a. 10 mL (3 offers) |
FOIS scale and visual perception of variables during FEES: |
10 controls (7 women) |
2. Evaluation of functionality and morphology of oropharyngeal structures |
b. Thick liquid (applesauce) |
b. 10 mL (3 offers) |
c. Solid (cracker) |
c. 1 piece of solid |
Multiple swallows |
Note: All foods colored blue. |
Latency at the beginning of the pharyngeal reflex |
3. Food bolus or liquid inserted into the oral cavity using a syringe |
Valecule residue after swallowing |
Residue on piriform sinuses after swallowing |
Laryngeal penetration or tracheal aspiration |
Somasundaram et al., 20143737 Somasundaram S, Henke C, Neumann-Haefelin T, Isenmann S, Hattigen E, Lorenz MW, et al. Dysphagia risk assessment in acute left-hemispheric middle cerebral artery stroke. Cerebrovasc Dis. 2014;37:217-22.
|
Middle cerebral artery acute stroke |
67 (all men) |
Initial visit - complete medical history; |
FEES performed by an experienced speech therapist and neurologist; Langmore Protocol 22 Langmore S. Endoscopic evaluation and treatment of swallowing disorders. 1st ed. New York: Thieme; 2001. p. 263.; |
1. Thickened liquid |
a. 3× thickened water |
Assessment of dysarthria, dysphonia, volitional cough, and gag reflex; |
2. Semi-solid |
b. 3× pudding |
Physical examination; EAT-10 before FEES; |
3. Liquid |
c. 3× water |
1. Structural evaluation |
4. Solid |
d. 3× white bread |
Penetration-aspiration scale |
Cynical Assessment of Swallowing - local protocol; FEES; |
2. Observation of secretion or saliva accumulation |
Note: All consistencies were stained with blue food coloring. |
Note: Quantities not specified. |
In the presence of pharyngeal residue, the patient was observed for 2 min to identify voluntary swallowing afterwards, for oral cleaning; |
Note: stroke unit patients screened by doctors and evaluated by a speech therapist 24 h after admission. |
3. Functional assessment of swallowing |
Leder et al., 20162222 Leder SB, Suiter DM, Agogo GO, Cooney LM Jr. An epidemiologic study on ageing and dysphagia in the acute care geriatrichospitalized population: a replication and continuation study. Dysphagia. 2016;31:619-25.
|
Hospitalized elderly |
961 (524 men) |
Yale Swallow Protocol FEES - with modified Langmore Standard Protocol, as a complementary assessment for some patients; Monitored by ENT doctor and speech therapist |
1. Visualization of the most patent nostril for passing an endoscope without anesthesia; |
a. Pasty (pudding) |
5 to 10 mL for each consistency |
Presence or absence of tracheal aspiration; |
b. Liquid (skim milk) |
c. Solid (cracker) |
2. Morphological evaluation of oropharyngeal structures; |
Note: Not specified if food was colored during the exams |
Functional swallowing defined with absence of aspiration; |
3. Functional assessment of swallowing |
Non-functional swallowing with the presence of aspiration in any of the consistencies tested during FEES. |
Marian et al., 20173232 Marian T, Schröder J, Muhle P, Claus I, Oelenberg S, Hamacher C, et al. Measurement of oxygen desaturation is not useful for the detection of aspiration in dysphagic stroke patients. Cerebrovasc Dis Extra. 2017;7:44-50.
|
Stroke |
50 (25 each sex) |
Screening for swallowing with water, in the presence of predictive symptoms of dysphagia, referral to FEES; Langmore Protocol with modifications; 6-point scale for stroke; Clinical monitoring by neurologist and speech therapist. |
1. Patients evaluated in bed with elevated headboard in a stroke unit |
a. Pasty (pudding) |
3 × 3 mL for each consistency |
Penetration-aspiration Scale - FEEDS scale - 6-point dysphagia severity scale in endoscopic evaluation (1 = the best performance and 6 = the worst performance) |
b. Liquid (not specified) |
c. Soft solid (white bread) |
2. Endoscope was passed through the most patent nostril with application of local anesthetic |
Note: All foods colored blue |
3. Secretion accumulation in the oropharyngeal region evaluated according to the severity scale |
|
4. Functional assessment of swallowing |
|
de Lima Alvarenga et al., 20182323 de Lima Alvarenga EH, Dall’Oglio GP, Murano EZ, Abrahão M. Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol. 2018;275:443-9.
|
Elderly >60 years |
100 elderly (58 women) |
Initial interview Modified Langmore Protocol Medical monitoring. |
Self-administered by the participant: |
a. Strawberry pudding |
a. 10 mL |
Evaluated as outcomes: |
1. Assessment of swallowing function |
b. Skim milk |
b. 50 mL in a glass |
1. Saliva stasis in the pharynx |
c. Cracker |
c. 1 cracker |
2. Pharyngeal residue |
Note: Foods colored green with food coloring. |
3. Laryngeal penetration |
4. Laryngotracheal aspiration |
5. Laryngeal sensitivity. |
Nienstedt et al., 20182727 Nienstedt JC, Buhmann C, Bihler M, Niessen A, Plaetke R, Gerloff C, et al. Drooling is no early sign of dysphagia in Parkinson’s disease. Neurogastroenterol Motil. 2018;30:e13259.
|
PD |
119 PD |
FEES with ENT doctor monitoring; |
1. Lidocaine application |
a. Liquid |
a. 90 mL water |
Penetration-aspiration scale, Murray scale short version |
32 Control |
b. Solid |
Assessments: MDS-UPDRS; H&Y scale; NMS-Quest; MOCA DSFS |
2. Functional assessment of swallowing |
c. Soft solid |
b. Cracker (91 mm and 20 g) |
c. Half a bread with butter (94 × 90 × 9 mm, 28 g) |
Pflug et al., 20182828 Pflug C, Bihler M, Emich K, Niessen A, Nienstedt JC, Flügel T, et al. Critical dysphagia is common in Parkinson disease and occurs even in early stages: a prospective cohort study. Dysphagia. 2018;33:41-50.
|
PD |
119 PD |
FEES with ENT doctors blinded to disease stages; MDS-UPDRS Evaluation H&Y scale NMS-Quest MOCA Assessment of depression - Beck questionnaire, German version |
1. Initial evaluation by ENT doctor with a request to: cough or throat clearing after eating or drinking; history of aspiration or pneumonia; |
a. Liquid |
a. Teaspoon for water |
Scale of swallowing restrictions - SSR |
32 Control |
b. Solid |
c. Soft solid |
b. 90 mL water with straw |
Penetration-aspiration scale |
c. 1 cracker (91 mm, 20 g) |
2. Functional assessment of swallowing |
d. Half a piece of bread with butter (95 × 90 × 9, 28 g) |
Premature leakage and waste. |
Umay et al., 20184040 Umay EK, Karaahmet F, Gurcay E, Balli F, Ozturk E, Karaahmet O, et al. Dysphagia in myasthenia gravis: the tip of the Iceberg. Acta Neurol Belg. 2018;118:259-66.
|
MG |
36 MG (20 women) |
FEES |
1. Without anesthesia |
a. Liquid |
a. Water (90 mL) |
A score of 1−6 was used for the degree of dysphagia (1 = normal swallowing and 2-6 = dysphagia - from mild to severe. |
Manometry |
2. Dzeiwas protocol |
b. Semi-solid |
b. Yogurt |
25 Control (14 women) |
EAT-10 |
c. Solid |
c. Cracker |
Surface electromyography |
VFD |
Braun et al., 20192424 Braun T, Juenemann M, Viard M, Meyer M, Reuter I, Prosiegel M, et al. Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study. BMC Neurol. 2019;19:282.
|
Post-stroke elderly |
152 (94 men) |
GUSS |
1. Nasal decongestant application (Xylometazoline) and local anesthesia (2% lidocaine gel) |
a. Pasty |
a. 3× water with thickener |
Rosenbek penetration-aspiration scale. |
FEES considering Langmore standard protocol for signs and symptoms of dysphagia |
b. Liquid |
b. 3× thin water |
c. Solid |
c. 3× solid (unspecified) |
Outcomes: FOIS, FEDSS |
2. Observation of anatomical structures, mobility of structures and saliva management |
Note: Offer in teaspoon; soup spoon; and sip from glass. |
3. Functional assessment of swallowing |
Farneti et al., 20194141 Farneti D, Fattori B, Bastiani L. Time as a factor during endoscopic assessment of swallowing: relevance in defining the score and severity of swallowing disorders. Acta Otorhinolaryngol Ital. 2019;39:244-9.
|
Different etiologies: PD, vascular dementia, stroke, TBI. |
16 adults (11 men) |
Own protocol with consistencies based on the global initiative FEES associated with penetration-aspiration scale, FOIS, and DOSS |
1. Functional assessment of swallowing |
a. Pasty |
a. 5cc puree |
Videos evaluated by 2 independent and experienced FEES evaluators. |
b. Solid |
b. 1∕4 cracker (salt and water) |
c. Liquid |
c. 5cc liquid |
Swallowing performance assessed using: Penetration-aspiration scale, FOIS, and DOSS. |
Outcome: average time for cleaning residues / consistency. |
Imaizumi et al., 20193434 Imaizumi M, Suzuki T, Matsuzuka T, Murono S, Omori K. Low-risk assessment of swallowing impairment using flexible endoscopy without food or liquid. Laryngoscope. 2019;129:2249-52.
|
Elderly people with different comorbidities: cerebrovascular disease, dementia, PD |
106 (76 women): |
FEES performed on patients at risk for dysphagia based on responses to two questionnaires such as EAT-10 Screening with FEES |
1. FEES performed by ENT doctor |
a. Degree of saliva accumulation in the vallecula and piriform sinuses; |
Saliva |
FEES associated with the Penetration-Aspiration Scale |
G1 - detectable swallowing alteration; |
2. Food-free assessment based on a system developed by Hyodo et al. |
b. Glottic closure reflex with touch of endoscope in epiglottis or arytenoid |
Level of care required |
Without food - to identify the severity of swallowing changes |
Consciousness level |
G2 - swallowing change not detectable |
Ability to eat orally |
c. Reflex of onset of swallowing based on white-out time |
Skills in activities of daily living |
d. Pharyngeal cleaning and clearance after swallowing 3 mL of colored water |
Suntrup-Krueger et al., 20192525 Suntrup-Krueger S, Schmidt S, Warnecke T, Steidl C, Muhle P, Schroeder JB, et al. Extubation readiness in critically ill stroke patients. Stroke. 2019;50:1981-8.
|
Acute stroke, recently extubated |
133 |
FEES performed 48 h after extubation monitored by a speech therapist and neurologist. |
1- Evaluation of secretion management |
a. Pasty |
Volumes not specified for each consistency |
Sensitivity (intact, reduced, or absent) |
b. Liquid |
c. Soft solid |
2- Observation of spontaneous swallowing per minute |
FEDSS >1 considered as dysphagia |
Extubation Assessments: |
3- Assessment of laryngeal sensitivity by touching pharyngolaryngeal structures |
3-ounce water swallow test performed 72 h after extubation and 24 h after FEES |
Glasgow coma scale; Body temperature; Heart beats; Systolic pressure; Spontaneous breathing in volume; Positive exhalation pressure; Rapid shallow breathing index |
4- FEES protocol validated for post-stroke patients |
Schröder et al., 20193535 Schröder JB, Marian T, Claus I, Muhle P, Pawlowski M, Wiendl H, et al. Substance P saliva reduction predicts pharyngeal dysphagia in parkinson’s disease. Front Neurol. 2019;10:386.
|
PD |
Cohort of 105 patients, 20 selected patients: |
Langmore Protocol |
1. Functional assessment of swallowing |
a. Pasty |
a. Green jelly |
Premature leakage |
b. Liquid |
Penetration-aspiration events |
c. Soft solid |
b. Blue colored water |
c. White bread (3 × 3×0.5 cm) |
Residues assessed using dysphagia severity scale of 0-3, where 0 = no swallowing changes and 3 = severe dysphagia (penetration-aspiration with 2-3 consistencies). |
G1 - 10 without signs of dysphagia; |
G2 - 10 with signs of pharyngeal dysphagia |
Substance P from saliva was collected in G1 and G2 |
Shapira-Galitz et al., 20193030 Shapira-Galitz Y, Yousovich R, Halperin D, Wolf M, Lahav Y, Drendel M. Does the Hebrew Eating Assessment Tool-10 correlate with pharyngeal residue, penetration and aspiration on fiberoptic endoscopic examination of swallowing? Dysphagia. 2019;34:372-81.
|
Stroke |
136 (25 from Kaplan Medical Center and 111 from Sheba Medical Center) |
Langmore Protocol with minor modifications |
1. Small amount of local anesthesia (2% Lidocaine hydrochloride gel) |
a. Pasty |
a. Applesauce with green dye (with spoon) |
Penetration-aspiration scale |
TBI |
b. Solid |
Degenerative neuromuscular diseases |
c. Liquid |
b. Whole meal bread (two pieces with crust and one without crust) |
Residues determined as 0 if absent in all consistencies and as 1 for residue presented in each consistency, with a maximum score of 3 if present in the three consistencies |
51 control |
2. Functional assessment of swallowing |
c. 3% fat milk with green dye (with straw and straight from the glass) |
Note: 3 offers of each consistency, with approximately 5cc of volume each bolus |
Souza et al., 20193838 Souza GAD de, Gozzer MM, Cola PC, Onofri SMM, Gonçalves da Silva R. Desempenho longitudinal da deglutição orofaríngea na distrofia miotônica tipo 1. Audiol Commun Res. 2019;24:e2114.
|
DM 1 |
1 (male, 66 years) |
Clinical swallowing evaluation |
1. FEES by ENT doctor and speech therapist |
a. Pasty |
a. Peach flavored dietary juice |
Laryngeal sensitivity |
FEES performed by doctor. |
b. Thickened liquid |
Premature oral leakage |
2. Assessment of laryngeal sensitivity |
Note: Consistencies according to IDDSI |
b. Juice with instant thickener |
Pharyngeal waste |
3. Functional assessment of swallowing |
Note: All consistencies were stained with blue food coloring. |
Laryngotracheal penetration and aspiration |
Consistencies offered in 3, 5 and 10 mL using disposable spoons |
Souza et al., 20193939 Souza GAD de, Silva RG da, Cola PC, Onofri Suely MM. Resíduos faríngeos nas disfagias orofaríngeas neurogênicas. CoDAS. 2019;31:e20180160.
|
Stroke |
G1: 10 (stroke - 8 men); |
FEES performed by physician |
1. FEES performed without anesthesia |
a. Pasty |
Note: All consistencies stained with blue food coloring (5 mL offered), without description of the number of offers and which foods for each consistency. |
Pharyngeal waste scale based on the YPRSSRS scale |
ALS |
b. Thickened liquid |
PD |
G2: 10 (ALS - 5 men); |
2. Functional assessment of swallowing with institutional protocol |
|
G3: 10 (PD - 5 men) |
Note: Consistencies according to IDDSI |
Institutional protocol for functional swallowing assessment |
2. Laryngeal sensitivity was assessed by touch with nasofibroscope on the aryepiglottic and arytenoid folds |
20 (13 men) |
FEES performed by ENT doctor and speech therapist concomitantly |
1. Structures observed in motion, initially with emission of the vowel ∕ i ∕ |
a. Pasty |
Note: Without details of the quantity offered in each consistency |
Posteriororal leakage; |
b. Thickened liquid |
c. Liquid |
Pharyngeal residue; |
Note: Consistencies according to IDDSI |
Laryngeal penetration; |
|
3. Functional assessment of swallowing |
Laryngotracheal aspiration |