From the Guidelines
Modified Barium Swallow Study (MBSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are crucial diagnostic tools for assessing swallowing disorders and guiding therapy, with the choice between them depending on the patient's condition, as noted in the 2019 study by the American College of Radiology 1.
Diagnostic Tools for Swallowing Disorders
MBSS involves consuming barium-coated foods and liquids of various consistencies while being recorded via X-ray fluoroscopy, providing a real-time view of the oral and pharyngeal phases of swallowing. This allows clinicians to observe aspiration, penetration, residue, and structural abnormalities. FEES, on the other hand, involves inserting a flexible endoscope through the nose to directly visualize the pharynx and larynx during swallowing, offering detailed assessment of secretion management, laryngeal sensation, and airway protection.
Therapy Techniques and Compensatory Strategies
These tests help speech-language pathologists determine appropriate therapy techniques, safe food consistencies, and compensatory strategies for patients, such as the Shaker head lift, chin-down technique, and effortful swallow, as discussed in the 2018 study on clinical nutrition in neurology 1. The choice between MBSS and FEES depends on the patient's condition, with MBSS better for visualizing the oral phase and FEES offering better assessment of secretion management and the ability to be performed bedside for critically ill patients, as highlighted in the 2021 update to the 2009 comprehensive nursing care scientific statement 1.
Importance of Follow-up Studies
Follow-up studies are often conducted to monitor progress during swallowing therapy, and patients, families, and caregivers should receive education on swallowing and feeding recommendations, as emphasized in the 2016 Canadian stroke best practice recommendations 1. The most recent and highest quality study, from 2021, supports the use of MBSS and FEES in guiding therapy for swallowing disorders, with a focus on improving patient outcomes and reducing the risk of complications 1.
From the Research
MBSS and FEES in Swallowing Disorder Therapy
- MBSS (Modified Barium Swallow Study) is a videofluoroscopic evaluation of the functional anatomy and physiology of swallowing, permitting visualization of bolus flow throughout the upper aerodigestive tract in real time 2.
- FEES (Fiberoptic Endoscopic Evaluation of Swallowing) is a valuable procedure for evaluating dysphagia, showing good agreement with diagnostic findings as related to tracheal aspiration, laryngeal penetration, pharyngeal residue, diet level, and compensatory swallow safety strategies 3.
- Both MBSS and FEES are considered the gold standard for evaluating swallow function, with their own advantages and disadvantages 3.
Applications of MBSS and FEES
- MBSS is used to identify and distinguish the type and severity of swallowing impairment, determine the safety of oral intake, test the effect of evidence-based frontline interventions, and formulate oral intake recommendations and treatment planning 2.
- FEES can provide information similar to and possibly even more complete than that supplied by the modified barium swallow, and can be used as an adjunctive method to help otolaryngologist-head and neck surgeons manage patients with swallowing difficulties 4.
- FEES can also be used to evaluate patients with dysphagia in an effort to reduce the incidence of pneumonia, and has been shown to have similar outcomes to MBSS in terms of pneumonia incidence and pneumonia-free interval 5.
Comparison of MBSS and FEES
- A study comparing MBSS and FEES found that both tests had similar outcomes in terms of pneumonia incidence and pneumonia-free interval, and that the choice of test may depend on the specific needs and circumstances of the patient 5.
- Another study found that FEES was a safe and effective treatment for dysphagia due to stroke, and resulted in better swallow function than conventional thermal-tactile stimulation treatment 6.