Comparing Simultaneous Clinical Swallow Evaluations and Fiberoptic Endoscopic Evaluations of Swallowing: Findings and Consequences

Introduction: Simultaneous blinded comparisons between the results of a clinical swallowing evaluation (CSE) and fiberoptic endoscopic evaluation of swallowing (FEES) were performed. Methods: Raters were two groups of speech-language pathologists (SLPs) with expertise in dysphagia. One group analyzed the FEES video alone and the other group analyzed the CSE video alone. No consistent agreement was found between the CSE and FEES raters regarding pharyngeal and laryngeal anatomy and physiology, bolus flow characteristics, and oral diet recommendations. Results: There was also no consensus on the need for instrumental testing. Watching the CSE video alone prevented expert SLPs who use a CSE from determining pharyngeal and laryngeal anatomy and physiology, bolus flow characteristics, silent aspiration, and making informed diet recommendations and intervention strategies. Watching the FEES video alone allowed expert SLPs who use FEES to determine pharyngeal and laryngeal anatomy and physiology and bolus flow characteristics and make evidence-based oral diet recommendations. Discussion: A CSE does not have good clinical utility for determining pharyngeal dysphagia. The consequences of these results will be discussed.