Question
How do you address or comment on edema when performing FEES?
Answer
Edema is not an uncommon finding on the endoscopic swallowing assessment. It is important to remember that as speech language pathologists, we do not render medical diagnosis information. The purpose of the exam is to assess function. It is part of the exam to recognize alterations in anatomy within the larynx and pharynx, which may include edema. There are different potential sources for edema which include manifestations of laryngopharyngeal reflux. The clinician can refer to the Reflux Finding Score (Belafsky, Postma, Koufman in Journal of Voice 2002, p.274-277), to help quantify location and severity of edema. This can be coupled with the Reflux Symptom Index done by Belafsky at al. where one can correlate the subjective complaints with the objective findings.
When reporting findings of edema in the report, the best practice is to provide a description of the location and the severity of the edema. In more severe cases of laryngeal edema the mucosa may begin to impact airway patency. This may correspond with vocal changes. The speech language pathologist should be aware of other potential sources of edema in the laryngopharynx. These may include and are not limited to: edema from post-operative head and neck cancer, vocal abuse/misuse, blunt force trauma, penetrating trauma, other medical conditions such as water-retention and certain allergic conditions.
Knowledge of potential edema etiology can help predict potential improvements in a patient's condition. The arytenoids cartilage edema may call for use of ani-reflux regimen. Edema from traumatic intubation may require future retesting, once the edematous areas have had time to heal following extubation. The SLP should refer to the physicians for a proper medical treatment plan for the edema and to allow the physician to render the medical diagnosis.
This Ask the Expert was taken from the course entitled: Endoscopic Swallowing Exam to Evaluate Dysphagia presented by Eric Blicker, M.A., CCC-SLP.D, BRS-S.
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Eric Blicker, M.A., CCC-SLP.D, BRS-S, is an ASHA board recognized specialist in swallowing disorders. Eric received his doctoral degree from Nova Southeastern University and was trained in FEESST by Dr Jonathan Aviv, the otolaryngologist who developed FEESST. He has provided FEES training courses in CT, MA, FL, MO, CA.
