History & Research
In addition to publishing on FEES, my research has focused primarily on outcomes of dysphagia. My first large NIH grant was an epidemiological study to follow a large number of inpatients, outpatients, and nursing home patients over 5 years for development of aspiration pneumonia. We enrolled 189 patients who had a variety of medical problems. About half of the patients were found to have dysphagia. About 22% of all patients (and 81% of patients with dysphagia) developed pneumonia; thus dysphagia was significantly associated with pneumonia. However, when we looked at all the other factors that were significantly associated with pneumonia, dysphagia and aspiration were way down the list – they were not as good a predictor of pneumonia as other factors such as dependent for oral care, presence of tooth decay, dependent for feeding, tube feeding, and multiple medical diagnoses. The take-away from this study is: Aspiration is necessary but not sufficient to develop pneumonia. When you identify dysphagia that includes aspiration, you must consider the other risk factors that are more likely to cause pneumonia! We speech language pathologists tend to be conservative when it comes to recommending a diet and we need to realize that some aspiration in some patients is benign. Quality of life is also important.
My second large research project was a clinical trial to determine whether aggressive exercise, either alone or combined with electrical stimulation, was beneficial for patients who had been treated with radiation therapy (with or without chemotherapy) for head neck cancer. We enrolled 170 patients who were randomized to one of 2 groups: exercise with or without added e-stim. Our interest in e-stim came from the growing popularity of this modality in the early 2000’s. It was widely used but with a very weak evidence base. The therapy program was intense, involving daily exercise over a period of 3 months. Results showed that swallowing did not improve as measured by physiologic measures of structural movement or from the PAS (Penetration-Aspiration) Scale – although there was a statistically significant but clinically insignificant improvement in PAS for thin liquids in the group that did not have estim. Surprisingly, diet and quality of life did show significant improvement in all patients. This was difficult to interpret but perhaps reflected a learning curve for patients who felt more confident in eating a wider range of foods as they progressed through the trial
Reference: Langmore et al., 2016. Efficacy of electrical stimulation and exercise for dysphagia in patients with head and neck cancer: A randomized clinical trial. Head Neck. 2016 Apr;38 Suppl 1
My current research is primarily based on improving FEES by working on a standardized method of scoring the recorded examination. This will enable FEES to be used in more research projects such as those I described above, as well as ensuring that our patients are being evaluated in a standard and accurate way.
Publications & Milestones
First publication: Langmore, Schatz, and Olson, Dysphagia, 1988.
FEES was first developed in response to a need for a more portable exam to replace the bedside clinical exam for inpatients. As its value as a stand-alone exam became better appreciated and as technology advanced, FEES has evolved to the point where today FEES is a standard instrumental exam that is widely done throughout the US and internationally.
FEES included in the SLP scope of practice by ASHA, 1991.
By identifying FEES as an evaluation procedure that is within the scope of practice of SLPs, ASHA established its credibility. They emphasized that training is needed to perform and interpret the exam and followed this document with a Position Statement on the role of the SLP and further documents that provided Knowledge and Skills needed to perform the exam. The ASHA website has these documents available to anyone.
FEES made a billable CPT procedures, 1994 (CPT – 92612)
In 1994, The Centers for Medicare and Medicaid Services determined that FEES should have its own CPT code, thus establishing it as a procedure that is separate and distinct from other procedures that utilize a laryngoscope. From that time on, FEES was no longer confused with CPT code # 31575, Diagnostic Laryngoscopy, as typically performed by otolaryngologists as their standard laryngoscopy exam to assess for laryngeal pathology.
Textbook on FEES published 2001.
A good resource for learning more about FEES is my textbook:Langmore, Susan E. Fiberoptic Endoscopic Evaluation and Treatment of Swallowing Disorders. Thieme Medical Publishers, 2001.