Studies for Evaluation of Aspiration

Aspiration occurs when food, liquids, saliva, or gastric contents enter the airway instead of the esophagus. Aspiration is commonly seen in children with neurological problems like cerebral palsy, neurodegenerative disorders, neuromuscular disorders, etc. Symptoms of aspiration include coughing/choking during feeding, recurrent pneumonia, wheezing, or unexplained weight loss.

1. Video Fluoroscopic Evaluation of Swallow (VFES)

• What It IsVFES, also known as a modified barium swallow study, is an X-ray procedure that assesses the swallowing process in real time.
• How It WorksThe child is given food and liquids of different consistencies mixed with a contrast agent (barium). Initially foods of thinner consistencies are given and later foods of thicker viscosities are given as tolerated. The typical protocol utilizes thin liquid (milk), thick liquid (thick juice), puree, and solid. X-ray imaging tracks the movement of the bolus through the mouth, pharynx, and esophagus.

Advantages

• Provides detailed visualization of oral, pharyngeal, and upper esophageal phases.
• Identifies penetration, aspiration, and any anatomical abnormalities.

Limitations

• Exposure to radiation.

2. Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

• What It IsFEES involves the use of a flexible fiberoptic scope to visualize the pharynx and larynx during swallowing.
• How It WorksA small scope is passed through the nostril to observe swallowing directly. The child is seated in a functional feeding position and are offered a variety of food consistencies as in a VFSS but without Barium. Coloured food or liquids are often used for better visualization. The study is seen live and recorded.

Advantages

• No radiation exposure.
• Can be performed bedside or in outpatient settings.
• Provides detailed views of laryngeal function and residue.

Limitations

• May cause discomfort or anxiety.
• Limited to pharyngeal phase evaluation.

The choice between VFES and FEES depends on the child’s symptoms, age, and ability to cooperate. VFES is often preferred for a comprehensive assessment of all swallowing phases, while FEES is ideal for detailed visualization of the pharyngeal phase and laryngeal structures.

Evaluating aspiration in children requires a tailored approach to ensure accurate diagnosis and effective treatment. Both Video Fluoroscopic Evaluation of Swallow and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are invaluable tools in this process, offering insights that guide management and improve outcomes.

Conclusion

Facilities for performing VideoFluoroscopic Evaluation of Swallow (VFES) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are available at BLK MAX Hospital.

Symptoms include coughing or choking during meals, recurrent respiratory infections, wheezing, and failure to thrive.

VFES involves giving the child barium-mixed food and liquids while X-rays capture real-time images of the swallowing process.

FEES uses a fiberoptic scope to visualize swallowing without radiation exposure, focusing on the pharyngeal phase and laryngeal function.

VFES involves radiation exposure, while FEES may cause mild discomfort or anxiety during scope insertion.

Yes, with appropriate dietary changes, therapy, and sometimes medical or surgical interventions, most children improve significantly.