Difficulty swallowing? Device gives health professionals live view of your throat – Duluth News Tribune

MITCHELL, SD — Swallowing is a complex process. With about 30 pairs of muscles working in perfect coordination, a person will swallow about 600 times a day, often without noticing.

Yet several studies estimate that as many as one in six American adults –

and most adults by age 80

— have some degree of difficulty swallowing. Whether it’s a natural cause or a diagnosable health condition, swallowing problems can affect your ability to eat, sleep, and breathe.

To diagnose and treat these problems, health care professionals may turn to surgery called fiberoptic endoscopic evaluation of swallowing, or FEES. It offers a new perspective on the throat and a look at possible problems with swallowing, which can be caused by tumors, edema or even natural muscle weakness.

During a FEES evaluation, a health care professional — often a speech therapist — will insert a tube into a patient’s nose until a small camera on the end of the tube can get a bird’s-eye view down a patient’s throat, usually to view the epiglottis to observe – a small flap that covers your windpipe when swallowing.

“For a lot of people [swallowing] is something that is so natural throughout life that you don’t really think about it as something that is affected by stroke, traumatic brain injury, age, or weakness,” said Kennedy Weiland, a speech therapist at Avera Therapy in Mitchell, South Dakota. . “We want to make sure that our airways remain protected.”

If the epiglottis does not rotate properly when swallowing, a patient may be at risk of aspirating food or drink, which can lead to a condition called aspiration pneumonia.

Since the arrival of FEES devices in Mitchell earlier this year, Weiland said she has conducted five evaluations on patients.

Kennedy Weiland IMG_6158.jpg

Kennedy Weiland, SLP

“I’ve been lucky, so far they were all normal, but [if abnormal]”We can find where the food gets stuck or where the fluid gets stuck and whether it gets into the airways,” Weiland said. “Sometimes a patient can’t aspirate, but the food or fluid gets stuck in the throat.”

Before the device needed for a FEES evaluation arrived, patients requiring a swallow evaluation were given a more complex barium swallow evaluation. In doing so, a patient would eat or drink something covered in barium and a radiologist would use X-rays to monitor the progress of the food or drink in the throat.
An evaluation of FEES does not completely replace the need for a barium evaluation, Weiland said. It depends more on a patient’s individual needs and what they are experiencing.

“With barium, we have more of a lateral side view, while the FEES gives us a better view of their secretions or edema or irritations, and we can’t really see that on the modified barium swallow. There are reasons to do both,” Weiland said. “It can be dangerous to move a patient to radiology [for a barium evaluation]while the FEES is mobile, so we can do it right at the bedside.”

Weiland said some patients who suffer from mobility or cognitive impairments or illnesses are more likely to receive one treatment than another, based on their comfort level.

“Someone with advanced Alzheimer’s isn’t going to be very comfortable with someone with a tube going down their throat,” Weiland said. “With excitement, putting them in a chair isn’t as complicated as taking X-rays.”

While it may be unnatural for patients to have a tube placed in their nose, Weiland said it doesn’t hurt like a COVID-19 test does. Weiland said it’s that simple, she tested herself.
“It’s pretty smooth, it goes a lot better if you just wet the end of the probe. The main thing that happens a lot is that the patient might start to sneeze, but once you get past a certain point, you feel nothing but pressure,” Weiland said. “We were actually able to do part of the training ourselves. If I get through it fifteen times, you get through it once.”

Because the device is relatively small, Weiland said, Avera can take it to pop-up clinics across the region, performing assessments on individuals who may not be able to take it easy in a facility where the device is available.


A barium swallow evaluation found a leak in a patient’s throat as part of a case in a medical journal.

Image Courtesy of the Acute and Critical Care Journal

“We can do it anywhere. We cover many outreach facilities and sometimes it can be very difficult to get the patient to a hospital for transport. This gives us the option of where we can come to the patient,” says Weiland.

If health professionals find a major problem with a patient’s swallowing, they can refer a patient for treatment. Some common examples of problems, including natural muscle breakdown, which can be enhanced by electrical training.

“An important way we do this is called neuromuscular electrical stimulation, where we hook electrodes to the swallowing muscles and contract them through the stimulation,” Weiland said, adding that certain oral motor exercises using the electrodes can help target muscles. to reinforce .

The evaluations are covered by Medicare, as patients who need a FEES evaluation are usually older. However, Weiland made it clear that most commercial insurance policies also cover it with a co-payment, as the evaluation is not limited to elderly patients.

Weiland said that although Mitchell is one of the first Avera properties to receive the FEES machine, expansions to Avera McKennan in Sioux Falls are planned this year. The technology could also be expanded to other Avera sites in the coming years.

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