Accuracy of Otolaryngology-performed Simplified Flexible Endoscopic Evaluation of Swallowing (S-FEES): A Retrospective Analysis.

Flexible endoscopic evaluation of swallowing (FEES) and modified barium swallow study (MBSS) are considered the gold standard studies for evaluating oropharyngeal swallow. In the United States, these studies are most commonly performed by speech-language pathologists (SLPs), although internationally FEES may be performed by otolaryngologists or other providers Limited literature exists on Otolaryngologist-performed FEES without the presence of SLP in the outpatient setting. This study presents the concept of Otolaryngology simplified screen FEES (S-FEES) and its accuracy compared to SLP-performed MBSS. A retrospective chart review of adult dysphagic patients presenting to an Otolaryngology clinic was performed, identifying patients who underwent Otolaryngology-performed S-FEES and SLP-performed MBSS within 3 months of each other. Demographic information and study findings were compiled and analyzed. Reliability and predictive values were calculated for S-FEES using SLP-performed MBSS as the standard. Overall, 89 patients, 52.8% male, with a mean age of 66.7 years, met the inclusion criteria. Within the group, 57.3% of patients were identified with normal S-FEES, 51.7% with normal laryngoscopy, and 68.5% with normal MBSS. Cohen's kappa for S-FEES and MBSS was 0.762. Otolaryngology performed S-FEES had 100% sensitivity and 85.9% specificity of detecting abnormal swallow when compared to SLP-performed MBSS. Positive and negative predictive values were 73.7% and 100%, respectively. Otolaryngology-performed S-FEES represents a streamlined application of the standard FEES protocol that can be readily incorporated into otolaryngology outpatient practice in the absence of an SLP. This simplified screen protocol demonstrated high sensitivity and negative predictive value for identifying patients who may benefit from referral for comprehensive swallowing evaluation by SLP.