Question
How do the results of FEESST impact dysphagia therapy?
Answer
FEESST sensory loss can be from different etiologies. A patient with edema at the area of testing at the arytenoid cartilage may have this edema secondary to laryngopharyngeal reflux. These patients may not be having severe dysphagia with aspiration risk, despite having the sensory loss. So your question is relevant in terms of what if a patient has sensory loss because of surface anatomy changes in the throat from reflux. Well, in a patient with this condition the treatment from the physician may be with a proton pump inhibitor for their reflux. The patient can then come back in eight weeks and repeat the sensory testing. This may show a reduction in the edema. Then a potential correlation can be drawn, that after the laryngo-pharyngeal reflux was treated and there may be an improvement in sensory function in the throat, as the edema resolves.
This may be a much different type of sensory testing if you are comparing it to an acute stroke patient who is hemiplegic. There may be more associated pharyngeal dysphagia symptoms with this type of patient. For example, if they are having their weakness on the left side of their body, and they are having pooling of bolus in the left side of the pharynx, a correlation may be drawn if you are sensory testing the left side and finding that it is impaired. There may be more sensory loss on the hemiplegia side compared to the unaffected side. Perhaps then, if you know that the sensory loss is severe on the left side before you have even given a bolus, then you could do a head turn to the left side and divert the bolus down the stronger right side, as soon as you observe bolus pooling where is already known that there is sensory loss. Those are just two of several examples where you can use sensory testing in your treatment plan.
This Ask the Expert was taken from the course entitled: Transnasal Endoscopic Assessment by Eric Blicker.
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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.
