Introduction
Methods
Subject Selection
Swallowing Assessment
Swallowing Measurements
FEES variable | Definition | Rating scale |
---|---|---|
Piecemeal deglutition | Sequential swallowing on the same bolus | 0 = one swallow 1 = two swallows 2 = three swallows 3 = four swallows 4 = five or more swallows |
Postswallow vallecular pooling | Bolus retention in the valleculae after swallowing | 0 = no pooling 1 = filling of less than 50 % of the valleculae 2 = filling of more than 50 % of the valleculae |
Postswallow pyriform sinus pooling | Bolus retention in the pyriform sinuses after swallowing | 0 = no pooling 1 = trace to moderate pooling 2 = severe pooling up to complete filling of the sinus |
Laryngeal penetration/tracheal aspiration | Bolus in the laryngeal vestibule above or on the level of the vocal folds (laryngeal penetration) or bolus passes below the vocal folds (tracheal aspiration) | 0 = no laryngeal penetration 1 = laryngeal penetration 2 = tracheal aspiration |
Statistical Analysis
Results
Characteristics of the Subjects
FEES variables | Rating scale | Etiology | |
---|---|---|---|
Oncological | Neurological | ||
Vallecular pooling | 0 | 78 (54) | 92 (63) |
1 | 47 (32) | 39 (27) | |
2 | 20 (14) | 15 (10) | |
Pyriform sinus pooling | 0 | 128 (75) | 131 (74) |
1 | 32 (19) | 45 (25) | |
2 | 10 (5.9) | 1 (0.6) | |
Piecemeal deglutition | 0 | 26 (15) | 39 (22) |
1 | 59 (34) | 74 (43) | |
2 | 36 (21) | 32 (18) | |
3 | 14 (8.1) | 10 (5.7) | |
4 | 37 (22) | 19 (11) | |
Penetration/aspiration | 0 | 79 (48) | 126 (75) |
1 | 59 (36) | 35 (21) | |
2 | 27 (16) | 7 (4.2) |
Number of Swallows Analyzed
Intraobserver Agreement
FEES variables | Intraobserver agreement | Interobserver agreement | Intrapanel agreement | |||
---|---|---|---|---|---|---|
Observer 1 | Observer 2 | Thin liquid | Thick liquid | Total | Total | |
Piecemeal deglutition | 0.86 (0.041) | 0.90 (0.026) | 0.84 (0.033) | 0.93 (0.019) | 0.88 (0.020) | 0.95 (0.029) |
Postswallow vallecular pooling | 0.93 (0.041) | 0.79 (0.068) | 0.30 (0.075) | 0.76 (0.040) | 0.65 (0.037) | 0.85 (0.071) |
Postswallow pyriform sinus pooling | 0.79 (0.054) | 0.76 (0.084) | 0.55 (0.071) | 0.67 (0.069) | 0.61 (0.059) | 0.91 (0.068) |
Laryngeal penetration/tracheal aspiration | 0.79 (0.064) | 0.79 (0.066) | 0.82 (0.037) | 0.58 (0.070) | 0.73 (0.035) | 0.93 (0.049) |
Piecemeal deglutition | Postswallow vallecular pooling | Postswallow pyriform sinus pooling | Laryngeal penetration/tracheal aspiration | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | |||||
Intercept | 1.45 (0.39) | 0.81 | 2.24 | −0.39 (0.65) | −1.57 | 0.88 | 0.93 (0.42) | 0.24 | 1.95 | 0.75 (0.34) | 0.029 | 1.41 |
Observera
| 0.12 (0.19) | −0.16 | 0.63 | 1.19 (0.61) | 0.016 | 2.34 | −0.067 (0.36) | −0.85 | 0.60 | −0.056 (0.27) | −0.61 | 0.46 |
Consistencyb
| −0.14 (0.25) | −0.66 | 0.34 | 0.80 (0.61) | −0.43 | 1.93 | −0.39 (0.30) | −1.02 | 0.18 | 0.27 (0.30) | −0.27 | 0.86 |
Groupc
| −0.23 (0.26) | −0.83 | 0.23 | 0.053 (0.51) | −1.16 | 0.95 | 0.22 (0.45) | −0.71 | 1.02 | −0.15 (0.34) | −0.86 | 0.48 |
σ
2
| 0.60 (0.60) | 0.0024 | 1.98 | 0.14 (0.24) | 0.00 | 0.79 | 0.14 (0.24) | 0.00 | 0.79 | 0.19 (0.17) | 0.00 | 0.59 |
Interobserver Agreement
Piecemeal deglutition | Postswallow vallecular pooling | Postswallow pyriform sinus pooling | Laryngeal penetration/tracheal aspiration | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | |||||
Intercept | 1.45 (0.21) | 1.08 | 1.88 | 0.70 (0.15) | 0.41 | 1.01 | 0.43 (0.19) | 0.072 | 0.80 | 0.36 (0.16) | 0.056 | 0.67 |
Consistencya
| −0.51 (0.17) | −0.86 | −0.19 | −0.86 (0.20) | −1.27 | −0.51 | −0.28 (0.18) | −0.66 | 0.081 | 0.64 (0.17) | 0.33 | 0.98 |
Groupb
| −0.14 (0.20) | −0.53 | 0.25 | −0.0011 (0.19) | −0.37 | 0.36 | −0.049 (0.21) | −0.48 | 0.34 | 0.012 (0.17) | −0.33 | 0.32 |
σ
2
| 0.18 (0.13) | 0.0045 | 0.48 | 0.051 (0.060) | 0.00 | 0.21 | 0.13 (0.086) | 0.0012 | 0.32 | 0.022 (0.017) | 0.00 | 0.063 |
Consensus Panel Agreement
Piecemeal deglutition | Postswallow vallecular pooling | Postswallow pyriform sinus pooling | Laryngeal penetration/tracheal aspiration | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | Mean (SD) | 95 % CI | |||||
Intercept | −1.09 (0.46) | −2.04 | −0.22 | −0.77 (0.24) | −1.26 | −0.30 | −0.62 (0.29) | −1.21 | −0.069 | −0.70 (0.25) | −1.19 | −0.21 |
Observera
| 0.20 (0.23) | −0.24 | 0.64 | −0.13 (0.21) | −0.54 | 0.28 | 0.73 (0.24) | 0.27 | 1.20 | 0.10 (0.21) | −0.30 | 0.52 |
Consistencyb
| 0.034 (0.23) | −0.41 | 0.48 | −0.38 (0.21) | −0.79 | 0.025 | 0.15 (0.22) | −0.29 | 0.59 | 0.30 (0.21) | −0.10 | 0.71 |
Groupc
| 0.12 (0.60) | −1.07 | 1.32 | 0.15 (0.27) | −0.38 | 0.68 | 0.21 (0.37) | −0.50 | 0.96 | 0.17 (0.29) | −0.39 | 0.76 |
σ² | 1.38 (1.14) | 0.33 | 4.05 | 0.16 (0.15) | 0.00 | 0.53 | 0.37 (0.31) | 0.036 | 1.18 | 0.20 (0.21) | 0.002 | 0.72 |