MITCHELL, SD — Swallowing is a complex process. Using about 30 pairs of muscles working in perfect coordination, a person will swallow about 600 times a day, often without noticing.
Yet various studies estimate that as many as 1 in 6 American adults — and most adults over the age of 80 — experience some degree of difficulty swallowing. Whether naturally occurring or due to a diagnosable health condition, difficulty swallowing can affect your ability to eat, sleep, and breathe.
To help diagnose and treat these issues, Avera Health this spring began performing fiberoptic endoscopic swallowing assessments, or FEES, an operation that gives healthcare professionals a new perspective on the throat that provides insight into potential swallowing problems, which can be caused by tumors, edema or even natural muscle weakness.
During a FEES assessment, a medical professional – often a speech therapist – inserts a small tube into a patient’s nose until a small camera at the end of the tube can get a bird’s eye view of a patient’s throat, usually to observe the epiglottis – a small flap that covers your trachea when swallowing.
“For many people, [swallowing] is something so natural throughout life that you don’t really think it’s something that will be affected by stroke, traumatic brain injury, age, or weakness,” Kennedy Weiland said. speech therapist at Avera Therapy on Kimball Street in Mitchell. “We want to make sure our airways stay protected.”
If the epiglottis does not turn over properly during a swallow, a patient is at risk of aspirating their food or drink, which could lead to a condition called aspiration pneumonia.
Since the FEES devices arrived at Mitchell earlier this year, Weiland said she has conducted five evaluations on patients, all of which turned out to be without major results.
“I’ve been lucky so far they’ve all been normal, but [if abnormal], we can find where the food gets stuck or where the liquid gets stuck and if it gets into the airways,” Weiland said. “Sometimes a patient may not aspirate, but the food or liquid gets stuck in the throat.”
Prior to the arrival of the device needed for a FEES assessment, patients requiring a swallowing assessment would receive a more complex barium swallow assessment. With this, a patient would eat or drink something coated in barium, and a radiologist would use x-rays to track the progress of the food or drink down the throat.
A FEES assessment does not completely replace the need for a barium assessment, Weiland said. It depends more on the individual needs of a patient and what they are going through.
“Barium gives us a more lateral view of the side, whereas FEES gives us a better view of their secretions or edema or irritation, 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 lower a patient into radiology [for a barium evaluation]while the FEES are mobile, so we can do it right at the bedside. »
Weiland said some patients who have mobility or cognition disorders or illnesses may be more likely to receive one treatment over another, depending on their level of comfort.
“A person with advanced Alzheimer’s disease won’t be very comfortable with someone who has a tube going up their throat,” Weiland said. “With the hustle and bustle, putting them in a chair isn’t as complex as getting x-rays.”
While it may be abnormal 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 was so simple, she performed tests on herself.
“It’s quite smooth, it goes a lot better if you just moisten the tip of the probe. The main thing that often happens is that the patient may start to sneeze, but once you get past a certain point, you won’t feel anything but pressure,” Weiland said. “We were actually able to do some of the training on our own. If I can cross it 15 times, you can do it once.
Because the device is relatively small, Weiland said Avera can take it to pop-up clinics throughout the region, performing assessments on people who might not be able to easily travel to a facility where the device is available.
“We can do it anywhere. We cover many nearby facilities, and it can sometimes be very difficult to get the patient up for transport to a hospital. It gives us the opportunity to come and see the patient,” Weiland said.
If healthcare professionals find a major problem with a patient’s swallowing, they can refer a patient for treatment. Some common examples of problems include natural muscle deterioration, which can be enhanced by power training.
“A major way of doing this is called neuromuscular electrical stimulation, where we hook electrodes to the swallowing muscles and contract them through stimulation,” Weiland said, adding that certain oral motor exercises with the help of the electrodes can help. to strengthen the targeted muscles. .
Assessments are covered by Medicare, as patients requiring a FEES assessment tend to be older. However, Weiland clarified that most commercial insurance also covers it with a copay, as the assessment is not limited to older patients.
Weiland said that while Mitchell is one of the first Avera properties to receive the FEES machine, expansions are planned at Avera McKennan in Sioux Falls this year. The technology may also expand to other Avera locations in the coming years.