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Risk of Aspiration Increased by Post-swallow Residue in Infant Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Julia Chang1, Tyler Okland2, April Johnson3
1Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, California, USA.
Insights
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) residue in the pyriform sinus and anterior commissure in infants increases aspiration risk. This finding is crucial for identifying swallowing difficulties in bottle-fed infants.
Area of Science:
- Pediatric Gastroenterology
- Clinical Swallowing Assessment
- Infant Feeding Disorders
Background:
- Aspiration is a significant risk in infants with feeding difficulties.
- Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is used to assess swallowing function.
- Identifying predictors of aspiration in infants is critical for timely intervention.
Purpose of the Study:
- To evaluate the association between post-swallow residue in specific subsites during FEES and the risk of aspiration in bottle-fed infants.
- To determine the diagnostic accuracy of FEES-identified residue for predicting aspiration in infants.
Main Methods:
- A retrospective matched-pairs cohort study comparing FEES and Videofluoroscopic Swallowing Study (VFSS) in infants under one year.
- Paired trials were matched by bolus consistency and bottle flow rate, with aspiration defined by the "or rule".
- Analysis included 87 matched pairs from 29 infants, with subgroup analysis for neonates (<1 month).
Main Results:
- Overall positive aspiration rate was 59%.
- Pyriform sinus residue (16% prevalence) increased aspiration risk (OR 5.4, p<0.01), as did anterior commissure residue (27% prevalence, OR 2.5, p=0.03).
- Anterior commissure residue showed higher diagnostic accuracy in neonates, while pyriform sinus residue accuracy was lower in neonates compared to older infants.
Conclusions:
- Post-swallow residue in the pyriform sinus and anterior commissure during FEES are significant indicators of aspiration risk in bottle-fed infants.
- The diagnostic value of specific residue subsites varies between neonates and older infants, highlighting age-specific considerations in FEES interpretation.
Objective:
To assess the risk of aspiration associated with post-swallow residue subsites in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in bottle-fed infants <1 year of age.
Methods:
This is a retrospective matched-pairs cohort study at an academic tertiary children's hospital. FEES and Videofluoroscopic Swallowing Study (VFSS) trials performed within the same infant <5 days apart were paired by matching bolus consistency and bottle flow rate. Positive aspiration was defined by the "or rule" in which aspiration is positive when either FEES or VFSS within a matched pair is positive.
Results:
Eighty-seven FEES-VFSS matched pairs from 29 patients (16 males; mean [SD] age, 2.9 [2.8] months) were included. The rate of positive aspiration, as defined by the "or rule", was 59% (51/87). In FEES, post-swallow pyriform sinus residue was present in 16% (14/87) and anterior commissure residue 27% (31/87). Risk of positive aspiration was increased by pyriform sinus residue (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.9-19.3, p < 0.01) and anterior commissure residue in FEES (OR 2.5, 95% CI 1.1-6.1, p = 0.03). In the neonate subgroup, <1 month of age, multivariate-adjusted analysis showed that anterior commissure residue had better diagnostic accuracy for aspiration than in older infants (overall 70% vs. 42%, p < 0.01; sensitivity 60% vs. 10%, p < 0.01), whereas pyriform sinus residue had worse accuracy (overall 41% vs. 70%, p = 0.02; sensitivity 13% vs. 43%, p = 0.02).
Conclusion:
This study demonstrates that pyriform sinus and anterior commissure residue during infant FEES were associated with fivefold and twofold increased risk of aspiration, respectively.
Level Of Evidence: 3:
Using a retrospective matched-pairs cohort, this study assesses the diagnostic accuracy of post-swallow residue in FEES for predicting aspiration. Laryngoscope, 134:1431-1436, 2024.
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