The role of FEES and the dysphagia team in the management of patients after stroke disease in Hospital České Budějovice
Abstract
Introduction: The prevalence of dysphagia in the general population is 6-16%. The dysphagia team focuses on dia-gnosis and treatment of dysphagia.
The dysphagia team consists of a clinical speech therapist, an otorhinolaryngologist and nurse (depending on the workplace). Other specialties such as radiologist, nutritionist and physiotherapist can also be a member of the team.
FEES (Flexible Endoscopic Evaluation of Swallowing) and VFSS (Videofluoroscopic Swallow Study) are used as the gold standard for objective examination of the dysphagia. Aim of the work: The aim of the work is to evaluate retrospectively the contribution of the dysphagia team working in the department of otorhinolaryngology in Hospital České Budějovice, in the care of patients after stroke disease indicated for examination from the Complex Cerebrovascular Center (CCC) in 2016-2020.
Material and methods: The retrospective study included 33 patients after stroke with clinical suspicion of dysphagia, who were referred from the CCC to the Counseling Center for Swallowing Disorders for objective examination of dysphagia. Results: In 9 patients (27.3%), dysphagia was ruled out during FEES, thus enabling oral intake without restrictions.
Dysphagia was confirmed in 24 patients (72.7%). Ten patients (30.3%) had a prolonged pharyngeal swallowing phase without food penetration into the airways.
Three patients (9.1%) had a bolus penetration into the airways during the examination, but it remained above the vocal cords and it was completely expelled from the airways (PAS 2). In 11 cases (33.3%) aspiration was found, of which nine cases (27.3% of all patients, 81.8% of patients with aspiration) involved silent aspiration without any attempt to expel bolus from the airways (PAS 8).
Conclusion: In 31 patients (94.0%) the benefit of examination by the dysphagia team was noted. In the case of 22 patients (66.7%), it was an adjustment of nutrition and swallowing rehabilitation with confirmed dysphagia.
Restrictions were lifted in 9 patients (27.3%) with false-positive screening and clinical examination. We observe a positive effect of long-term swallowing rehabilitation in 61.5% of the monitored patients.