MITCHELL, S.D. — Swallowing is a complex process. Using roughly 30 pairs of muscles working in perfect coordination, a person will swallow around 600 times each day, often without noticing.
Yet various studies estimate that as many as one in six American adults — and most adults by age 80 — experience some degree of difficulty swallowing. Whether it’s caused naturally or a diagnosable health condition, trouble swallowing can affect your ability to eat, sleep and breathe.
To help diagnose and treat these issues, health care professionals can turn to an operation called fiberoptic endoscopic evaluation of swallowing, or FEES. It offers a new perspective on the throat, giving a look at potential issues with swallowing, which can be caused by tumors, edemas or even natural muscle weakening.
During a FEES evaluation, a health care professional — often a speech language pathologist — will insert a small tube into a patient’s nose until a tiny camera on the tube’s end can obtain a bird’s eye view down a patient’s throat, typically to observe the epiglottis — a small flap that covers your windpipe when swallowing.
“For a lot of people, [swallowing] is something that’s so natural throughout life that you don’t really think of that being something that will be affected by a stroke, traumatic brain injury, age or weakness,” said Kennedy Weiland, a speech language pathologist at Avera Therapy in Mitchell, South Dakota. “We want to make sure that our airway is staying protected.”
If the epiglottis isn’t flipping properly during a swallow, a patient could be at risk of aspirating their food or drink, which could lead to a condition called aspiration pneumonia.
Since the arrival of FEES devices in Mitchell earlier this year, Weiland said she’s conducted five evaluations on patients.
“I’ve been lucky, so far they’ve all been normal, but [if abnormal], we can find where the food is getting stuck or where the liquid is getting stuck and if it’s getting into the airway,” Weiland said. “Sometimes a patient may not be aspirating, but the food or liquid is getting stuck in the throat.”
Before the device needed for a FEES evaluation arrived, patients in need of a swallow evaluation would be given a more complex barium swallow evaluation. With that, a patient would eat or drink something coated in barium and a radiologist would use x-rays to track the progress of the food or drink down the throat.
A FEES evaluation doesn’t completely replace the need for a barium evaluation, Weiland said. It depends more on the individual needs of a patient and what they’re experiencing.
“Barium gets us more of a lateral view on the side, whereas the FEES gives us a better look at their secretions or edema or irritations, and we can’t really see that on the modified barium swallow. There’s reasons to do both,” Weiland said. “It can be dangerous to get a patient moved down to radiology [for a barium evaluation], whereas the FEES is mobile, so we can do it right at the bedside.”
Weiland said some patients who suffer from mobility or cognizance disorders or diseases may be more likely to receive one treatment over the other, based on their comfort level.
“Someone with advanced Alzheimer’s isn’t going to be very comfortable with someone who has a tube that’s going to go up their throat,” Weiland said. “With agitation, putting them in a chair isn’t as complex as getting X-rays.”
Though it may be unnatural for patients to have a tube placed up their nose, Weiland said it doesn’t hurt the way a COVID-19 test does. Weiland said it’s so simple, she’s conducted tests on herself.
“It’s pretty smooth, it goes a lot better if you just moisten the end of the probe. The main thing that happens a lot is the patient might start sneezing, but once you’re past a certain point, you won’t feel anything but pressure,” Weiland said. “We actually were able to do some of the training on ourselves. If I can get through it 15 times, you can get through it once.”
Because the device is relatively small, Weiland said Avera can take it to pop-up clinics across the region, performing evaluations on individuals who may not be able to easily make it into a facility where the device is available.
“We can do it anywhere. We cover a lot of outreach facilities, and sometimes it can be really hard to get the patient up for transportation to go to a hospital. This gives us the option where we can come to the patient,” Weiland said.
If health professionals find a major issue with a patient’s swallowing, they can refer a patient for treatment. Some common examples of issues including natural muscle deterioration, which can be strengthened through an electric workout.
“A major way we do this is called neuromuscular electrical stimulation, where we hook electrodes up to the swallowing muscles and contract them through the stimulation,” Weiland said, adding that certain oral motor exercises with the assistance of the electrodes can help strengthen targeted muscles.
The evaluations are covered by Medicare, as patients in need of a FEES evaluation tend to be older. However, Weiland made clear that most commercial insurances also cover it with a co-pay, as the evaluation is not limited to older patients.
Weiland said that while Mitchell is one of the first Avera properties to receive the FEES machine, expansions are planned to Avera McKennan in Sioux Falls this year. The technology could also expand to other Avera sites in future years.
Trouble swallowing? Device gives health professionals live view of your throat – Duluth News Tribune