[Quality Assurance in the Endoscopic Evaluation of Swallowing (FEES)]

A fiberoptic endoscopic evaluation of swallowing (FEES) is well established internationally as gold standard of the instrument-based diagnostics if it is performed according to the Langmore-protocol. For the quality assurance of FEES, videotaping is recommended. However, often no videotaping is carried out due to a limited availability of portable recording systems, for instance, in the bedside diagnostics. This study aimed at the comparison of FEES quality assurance with and without videotaping by rating of the main finding in swallowing disorders, the penetration and aspiration, as defined in the penetration-aspiration scale by Rosenbek.

An examination of agreement of penetration and aspiration ratings with the defined reference standard was conducted by means of 80 videotaped recordings. The ratings were carried out independently by 4 raters in 2 settings: A) "real time" and B) "frame-by-frame".

As far as the interrater- and intrarater-reliability is concerned, the association between the ratings in the rating setting B were higher than those in the rating setting A. Furthermore, examination of the validity showed higher correlation in setting B than in setting A. The difference between correlations was significant in favor of setting B (videotaped FEES).

The results of the present study, namely better rating reliability and validity in case of the penetration and aspiration, emphasize the importance of the videotaping of the FEES diagnostics, at least for the evaluation of penetration or aspiration.