As a portable alternative to videofluoroscopy, fibreoptic endoscopic evaluation of swallowing (FEES) is often carried out at the patient’s bedside. The authors of this paper have chosen to examine the reliability of the penetration-aspiration ratings (Rosenbek scale) of FEES examinations when rated, having the full advantage of video recordings (frame by frame analysis and repeat viewings) compared with a single viewing of the examination on a 7.5 inch screen to simulate real time FEES examinations. Eighty exams (10 for each score on the PAS scale) as rated by ‘master’ raters, were presented in random sequences to four ENT clinicians experienced in FEES. They were required to determine the PAS score under the ‘without video’ scenario. This was repeated two weeks later. Six months later, the same ENTs were presented with the same examinations (re-randomised) but with access to the video recordings played as many times as necessary and / or using frame by frame features to rate the exam played on a standard 17-inch screen (with video scenario). Repeat ratings in re-randomised sequence were once again done after a two-week interval. Inter-rater, intra-rater and concurrent validity were assessed for both evaluation methods using the PAS scale. The authors’ overall conclusion was that the detection of aspiration-penetration without video recording was not as reliable as with video recording. Concurrent validity as measured by comparison with a reference standard rated by ‘master’ raters was also better for the video method of evaluation. They also suggest that this benefit could be greater if the raters were less experienced than the clinicians who participated in this study. This is a useful paper to read, particularly if putting together a bid for FEES equipment. Do however bear in mind that video recording offers much more than the focus in this paper – including a permanent record for future comparison, biofeedback for the patient, visual and personalised education about swallow function for the patient and family and the opportunity to have multiple clinicians view and discuss findings.

Penetration–aspiration: is their detection in FEES reliable without video recording?
Hey C, Pluschinski P, Pajunk P, Almahameed A, Girth L, Sader R, Stover T, Zaretsky Y.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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