[New scoring proposed for endoscopic swallowing evaluation and clinical significance]

Dysphagia is becoming a critical medical and social issue with aging population. Appropriate treatment requires that swallowing be assessed objectively. The simple, clinic-based scoring we developed for flexible endoscopic evaluation of swallowing (FEES) uses four parameters--(1) the salivary pooling degree at the vallecula and piriform sinuses, (2) the glottal closure reflex induced by touching the epiglottis or arytenoid with the endoscope, (3) swallowing reflex initiation assessed by "white-out" timing, and (4) pharyngeal clearance after blue-dyed water is swallowed-categorized as 0 for normal, 1 for mildly impaired, 2 for moderate, or 3 for severe. Scores given by experienced otolaryngologists expert in treating dysphagic subjects correlated significantly with those of nonexpert otolaryngologists and speech-language-hearing therapists. Pharyngeal clearance evaluated by videofluorography correlated with FEES clearance scores, as did aspiration severity with total scores statistically significantly. Feeding procedures related significantly to total scores for the four parameters, indicating its usefulness in deciding oral food intake. Our new scoring is thus simple and reliable in evaluating dysphagia severity and features, and potentially clinically advantageous.