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The role of fiberoptic endoscopic evaluation of swallowing in the assessment of pediatric dysphagia




Swallowing is a basic, life-sustaining function that involves interplay between two distinct but related phenomena, airway protection and bolus transport. Pediatric dysphagia is one of the most important symptoms to be assessed and managed. The standard fiberoptic endoscopic evaluation of swallowing (FEES) protocol of Langmore (2001) was designed to assess dysphagia on all populations.


The aim of this work was to clarify the role of FEES in the diagnosis of pediatric dysphagia and the signs related to it.

Study design

This was a retrospective study that was conducted to assess pediatric dysphagia using FEES as a clinical diagnostic tool.

Participants and methods

The study included 64 children (38 male, 26 female). Of them, 32 patients were suffering from difficulty in swallowing of different degrees and 32 were controls (they were not suffering from any difficulty in swallowing). The mean age in months for symptomatic children was 41.47 ± 36.25 and the mean age in months for control cases was 42.08 ± 35.61. The examination was carried out using FEES applying the standard FEES protocol of Langmore (2001).


Application of the standard FEES protocol of Langmore (2001) showed highly related signs of pediatric dysphagia, such as handling of secretions, pharyngeal function in part I and timing of the bolus flow/initiation of the swallow, structural movements during the swallow, and residue after the swallow and between swallows in part II.

Conclusion and recommendation

There are more common signs related to pediatric dysphagia than others and should be considered in any therapeutic program for overcoming dysphagia in children. Laryngomalacia is a structural disorder causing pediatric dysphagia in a considerable number of children. The standard FEES protocol should be applied on a larger number of pediatric populations with different disorders.


  1. Arvedson J, Rogers B. Pediatric swallowing and feeding disorders. J Med Speech Lang Pathol 1993; 1: 203–221.

    Google Scholar 

  2. Logemann J. Evaluation and treatment of swallowing disorders. 2nd ed. Austin, TX: Pro-Ed; 1998.

    Google Scholar 

  3. Justice L. Communication sciences and disorders: an introduction. New Jersey: Pearson Education; 2006.

    Google Scholar 

  4. Munyard P, Bush A. How much coughing is normal? Arch Dis Child 1996; 74: 531–534.

    Article  CAS  Google Scholar 

  5. Langmore S. Endoscopic evaluation and treatment of swallowing disorders. New York: Thieme; 2001.

    Google Scholar 

  6. Lefton-Greif MA, Arvedson JC. Pediatric feeding and swallowing disorders: state of health, population trends, and application of the international classification of functioning, disability, and health. Semin Speech Lang 2007; 28: 161–165.

    Article  Google Scholar 

  7. Hawdon JM, Beauregard N, Slattery J, Kennedy G. Identification of neonates at risk of developing feeding problems in infancy. Dev Med Child Neurol 2000; 42: 235–239.

    Article  CAS  Google Scholar 

  8. Field D, Garland M, Williams K. Correlates of specific childhood feeding problems. J Paediatr Child Health 2003; 39: 299–304.

    Article  CAS  Google Scholar 

  9. Logemann JA, Veis S, Colangelo L. A screening procedure for oropharyngeal dysphagia. Dysphagia 1999; 14: 44–51.

    Article  CAS  Google Scholar 

  10. Linden P, Siebens A. Dysphagia: predicting laryngeal penetration. Arch Phys Med Rehabil 1983; 64: 281–284.

    CAS  PubMed  Google Scholar 

  11. Murray J, Langmore SE, Ginsberg S, Dostie A. The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration. Dysphagia 1996; 11: 99–103.

    Article  CAS  Google Scholar 

  12. Volonte MA, Porta M, Comi G. Clinical assessment of dysphagia in early phases of Parkinson’s disease. Neurol Sci 2002; 23: Suppl 2:S121–S122.

    Article  Google Scholar 

  13. Yoshida M, Kikutani T, Tsuga K, Utanohara Y, Hayashi R, Akagawa Y. Decreased tongue pressure reflects symptom of dysphagia. Dysphagia 2006; 21: 61–65.

    Article  Google Scholar 

  14. Mann G, Hankey GJ. Initial clinical and demographic predictors of swallowing impairment following acute stroke. Dysphagia 2001; 16: 208–215.

    Article  CAS  Google Scholar 

  15. Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in postdeglutition retention in the elderly. Dysphagia 1997; 12: 63–67.

    Article  CAS  Google Scholar 

  16. Horner J, Massey EW, Riski JE, Lathrop DL, Chase KN. Aspiration following stroke: clinical correlates and outcome. Neurology 1988; 38: 1359–1362.

    Article  CAS  Google Scholar 

  17. Daniels S, McAdam C, Brailey K, Foundas A. Clinical assessment of swallowing and prediction of dysphagia severity. Am J Speech Lang Pathol 1997; 6: 17–24.

    Article  Google Scholar 

  18. Daniels SK, Ballo LA, Mahoney MC, Foundas AL. Clinical predictors of dysphagia and aspiration risk: outcome measures in acute stroke patients. Arch Phys Med Rehabil 2000; 81: 1030–1033.

    Article  CAS  Google Scholar 

  19. McCullough GH, Wertz RT, Rosenbek JC. Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke. J Commun Disord 2001; 34: 55–72.

    Article  CAS  Google Scholar 

  20. Richter GT, Wootten CT, Rutter MJ, Thompson DM. Impact of supraglottoplasty on aspiration in severe laryngomalacia. Ann Otol Rhinol Laryngol 2009; 118: 259–266.

    Article  Google Scholar 

  21. Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr Otorhinolaryngol 2007; 71: 889–895.

    Article  Google Scholar 

  22. Durvasula VS, Lawson BR, Bower CM, Richter GT. Supraglottoplasty in premature infants with laryngomalacia: does gestation age at birth influence outcomes? Otolaryngol Head Neck Surg 2014; 150: 292–299.

    Article  Google Scholar 

  23. Logemann J. A manual for videofluoroscopic evaluation of swallowing. 2nd ed. Austin, TX: Pro Ed; 1993.

    Google Scholar 

  24. Manrique D, Melo E, Buhler R. Nasoendoscopic evaluation of deglutition in children. Rev Bras Otorrinolaringol 2001; 67: 796–801.

    Article  Google Scholar 

  25. Delgado S, Almeida S, Pinto R, Cruz L. Evaluation and treatment of children hospitalized with dysphagia. Themes on Development 2001; 9: 35–39.

    Google Scholar 

  26. Friedman B, Frazier JB. Deep laryngeal penetration as a predictor of aspiration. Dysphagia 2000; 15: 153–158.

    Article  CAS  Google Scholar 

  27. Veis SL, Logemann JA. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 1985; 66: 372–375.

    CAS  PubMed  Google Scholar 

  28. Smith CH, Logemann JA, Colangelo LA, Rademaker AW, Pauloski BR. Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia 1999; 14: 1–7.

    Article  CAS  Google Scholar 

  29. Rogers B, Arvedson J, Msall M, Demerath R. Hipoxemia during oral feeding of children with severe cerebral palsy. Dev Med Child Neurol 1993; 35: 3–10.

    Article  CAS  Google Scholar 

  30. Richardson BE, Bastian RW. Videoendoscopic swallowing study for diagnosis of Zenker’s diverticuli. Laryngoscope 1998; 108: 721–724.

    Article  CAS  Google Scholar 

  31. Suskind DL, Thompson DM, Gulati M, Huddleston P, Liu DC, Baroody FM. Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation? Laryngoscope 2006; 116: 1397–1403.

    Article  Google Scholar 

  32. Fishbein M, Branham C, Fraker C, Walbert L, Cox S, Scarborough D. The incidence of oropharyngeal dysphagia in infants with GERD-like symptoms. J Parenter Enteral Nutr 2013.; 37:667–673.

    Article  Google Scholar 

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Ahmed-Abdelhamid, M., Sarwat, S.A. The role of fiberoptic endoscopic evaluation of swallowing in the assessment of pediatric dysphagia. Egypt J Otolaryngol 32, 67–74 (2016).

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