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Modified Monday: Seeing double?

We recently teamed up with a local FEES provider in our Cleveland market- thanks again so much to Sarah Vacha with Cardinal Voice and Swallowing! - to collaborate on a simultaneous MBS and FEES study on yours truly. (If you've not read our prior #ModifiedMondays- yes, I am aware I have a small epiglottis and no, I don't want to talk about it.) Still working on editing and synching up the videos, but this one was interesting and worth the share. Here we see a few sips of thin Varibar barium via straw.

What may be the most interesting thing to see here is the different appearance between images of the pharynx after the swallow. On the MBS, it looks pretty clear and normal (if I do say so myself)... while on the FEES we see what appears to be prevalent residues at first glance. We discussed and decided it this was due to the opacity of the barium (which is not as frequently used in FEES), coupled with the reflection of light back to the scope and the clinging of the barium to secretions that skewed us toward the perception of residues. (More on this topic-see below for an article on simultaneous FEES and MBS in which residues were judged to be more severe when scored solely on the FEES images when compared to scoring of the MBS images.) It's worth noting again that we used Varibar, which is specifically created to decrease the coating factor, so using a non-Varibar product could have increased this appearance and biased the observer even more toward judging this to be residues, rather than normal appearance.(Maybe next time Sarah?)

Clips like this are fun to see (again in my humble opinion), but also a great reminder of the valuable information that both types of imaging studies can provide.

Stay tuned in the coming weeks for more clips and information from this cooperative work!

Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing (“SIRFES”) in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia | SpringerLink

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