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Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?

Langmore, Susan E.

Current Opinion in Otolaryngology & Head and Neck Surgery: December 2003 - Volume 11 - Issue 6 - p 485-489
Laryngology and bronchoesophagology

Purpose of review As flexible endoscopic examinations of swallowing become more widely used to evaluate patients with oropharyngeal dysphagia, it is important to be aware of research regarding the efficacy of this procedure as compared with the videofluoroscopy procedure. A recent evidence-based review of the field threw some long-held findings into question and has stimulated a surge of new research studying the sensitivity of the two instrumental examinations, health outcomes of patients who receive each procedure, and a look at different patient outcomes.

Recent findings Since 1999, one quasi-randomized clinical trial has directly compared outcomes of patients given a fluoroscopy versus a fiberoptic endoscopic evaluation of swallowing (FEES) examination. This study showed no significant difference in pneumonia rates between the two groups of patients. A multitude of studies have shown a high level of agreement between the two instrumental examinations, and the use of the term gold standard as applied to fluoroscopy is no longer appropriate. The attempt to standardize each examination has been slow, and inter-judge reliability of results has come under fire. Several new scales for quality of life and functional status are now ready to be applied to research that can measure outcomes other than pneumonia.

Summary Research to date has suggested that both instrumental examinations are valuable. It is likely that both will continue to be used and will be seen as complementary rather than competitors.

From the Departments of Otolaryngology-Head & Neck Surgery and Neurology, University of California, San Francisco, California, USA

Correspondence to Susan E. Langmore, PhD, UCSF Speech and Swallowing Center, 2380 Sutter St., San Francisco, CA 94143-1703, USA

Tel: 415-502-1931; fax: 415-502-4868; e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.