الفهرس 
Endoscopic Anatomy of Nasal and Pharyngeal CavitiesOnly 14 pages are availabe for public view
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Abstract
Susan Langmore (1988) described a fiberoptic endoscopic evaluation of swallowing (FEES) as a procedure to assess oropharyngeal dysphagia. Initially, it was presented as an alternative to the fluoroscopy procedure, indicated only when fluoroscopy was not available. Over the years, however, the usefulness of the endoscopy has become better appreciated, and today it is widely used in many cities across the United States and in many countries overseas as a standard tool for diagnosing and treating dysphagia. Phoniatricians and the speech – language pathologists use endoscopy to diagnose dysphagia, to assess the nature of the problem, and to guide its dietary and behavioral management.
Langmore et al. (1988) in their first article about the fiberoptic endoscopic evaluation of swallowing (FEES), referred to it as the FEESS procedure, or fiberoptic endoscopic evaluation of swallowing safety. They suggested that by using the fiberoptic endoscopy swallowing function could not be evaluated, only swallowing safety could. However, as this tool continued to be used, it was realized that swallowing function could often be determined, and in some cases endoscopy uncovered the reason for the dysphagia better than fluoroscopy did. The critical findings of aspiration, penetration, spillage, and residue were detected as often with endoscopy as with fluoroscopy and underlying cause for these “bolus flow” abnormalities could usually be determined by using either tool.
Langmore (2001) described the uses of FEES in the assessment of the anatomy and physiology of the pharyngeal and laryngeal muscles and the assessment of the swallowing function.
“FEES” is a comprehensive assessment of swallowing. It includes five components:
1. Observation of the anatomy involved in the oropharyngeal stage of swallowing.
2. Observation of the movements and sensation of critical structures within the hypo-pharynx.
3. Observation of secretions.
4. Direct assessment of swallowing function for food and liquid.
5. Response to therapeutic maneuvers and interventions to improve the swallow
Langmore (2001) has also described the FEES as a therapeutic examination used to guide treatment of the patient in several ways. First, during the procedure, the examiner will determine if any dietary and behavioral interventions help the patient with dysphagia to swallow more safely or more effectively. Second, during and after the FEES examination, the previously video-recorded study is used to educate the patient, caregivers, and other staff about the problem. During this initial procedure or in subsequent procedures, endoscopy may be used as a biofeedback tool to help the patient learn various behavioral strategies. After a period of treatment, or as the patient‘s status changes for other reasons, a repeated FEES examination can be done to reevaluate the dysphagia and further guide dietary and behavioral interventions.
“FEES” is not a replacement for the more comprehensive videofluoroscopy procedure, but it is a better choice for some patients, in some settings, and for revealing certain clinical findings. Each procedure is valuable and the decision of which one is indicated should be based on many factors, including the availability, cost, patient symptoms and sensitivity of each procedure to the nature of the problem. When used to assess swallowing functions, both the fluoroscopy and endoscopy examinations have identical outcomes; that is, both can identify a dysphagia and both purport to explain the pattern of dysphagia. The fluoroscopy examination provides a more comprehensive view of the oral, pharyngeal and esophageal structures as the bolus flows through them (physiology), whereas the endoscopic examination provides a more detailed view of the pharyngeal and laryngeal structures (anatomy).
FEES has several advantages: the patient does not have to be taken to a radiology suite, the equipment does not have to be adapted to accommodate the immobile patients, no contrast medium is needed, and no limits on data collection are imposed by radiation safety standards. On the other hand, some patients are difficult to examine with endoscopy; notably small children, uncooperative adults, nose bleeders, patients with hypersensitive gag reflexes or with severe involuntary movements.