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

Mitchell, SD. Swallowing is a complex process. Using approximately 30 pairs of muscles working in perfect coordination, a person would swallow about 600 times each day, often without noticing.

However, various studies estimate that up to one in six American adults –

Most adults are 80

You have some degree of difficulty swallowing. Whether caused by a normal or diagnosable health condition, a swallowing problem can affect your ability to eat, sleep, and breathe.

To help diagnose and treat these problems, health care professionals can turn to a process called fibrous endoscopic evaluation of swallowing, or FEES. It offers a new perspective on the throat, taking a look at potential problems with swallowing, which can be caused by tumors, edema, or even normal muscle weakness.

During a FEES evaluation, a health care professional — often a speech pathologist — inserts a small tube into the patient’s nose so that a small camera at the end of the tube can get a bird’s eye view down the patient’s throat, usually to monitor the epiglottis — the small flap covering the windpipe when swallowing;

“To many people, [swallowing] Kennedy Welland, MD, a speech-language pathologist with Avera Therapy in Mitchell, South Dakota. “We want to make sure our airway remains protected.”

If the epiglottis does not turn properly during swallowing, the patient may be at risk of inhaling their food or drink, which can lead to a condition called aspiration pneumonia.

Since the FEES devices arrived at Mitchell earlier this year, Weiland said it has conducted five evaluations on patients.

Kennedy Wayland IMG_6158.jpg

Kennedy Welland, SLP

“I was lucky, they were all normal so far, but [if abnormal]”We can find where the food is getting stuck or where the liquid is getting stuck and whether it’s getting into the airway,” Welland said. “Sometimes the patient may not be inhaling, but food or liquid getting stuck in the throat.”

Before the device required to evaluate FEES arrives, patients who require swallow evaluation will be given a more complex evaluation of a barium swallow. In doing so, the patient eats or drinks something covered with barium and the radiologist uses an X-ray to track the progress of food or drink into the throat.
Weiland said the FEES assessment does not completely replace the need to evaluate the barium. It depends more on the individual needs of the patient and what they suffer from.

“Barium gives us more of a side view, while FEES gives us a better look at their secretions or edema or irritation, and we can’t really see that on a modified barium swallow. There are reasons to do both,” Wayland said. Patient to the radiology department [for a barium evaluation], while it’s animated, so we can do it right next to the bed. “

Weiland said some patients with movement or cognition disorders or disturbances may be more likely to receive treatment over the other, based on their comfort level.

“A person with advanced Alzheimer’s disease will not feel comfortable with someone who has a tube that will go up their throat,” Welland said. “With excitement, putting them in a chair isn’t as complicated as getting an X-ray.”

Although it may be unnatural for patients to have a tube in their nose, Welland said it doesn’t hurt the way COVID-19 testing happens. It’s very simple, Weiland said, she did tests on herself.
“It’s very smooth, and it will be a lot better if you moisten the end of the probe. The main thing that happens a lot is that the patient might start sneezing, but once you get past a certain point, you won’t feel anything but pressure,” Welland said. Than do some exercises on ourselves. If you can get past it 15 times, you can get past it once.”

Because the device is relatively small, Weiland said Avera can take it to pop-up clinics across the region, and perform assessments for individuals who may not be able to easily transfer it to a facility where the device is available.


An evaluation of a barium ingestion found a leak in a patient’s throat as part of a case appearing in a medical journal.

Image courtesy of Acute and Critical Care Journal

“We can do it anywhere. We cover a lot of outreach facilities, and sometimes it can be really difficult to get a patient to hospital. That gives us the option where we can come to the patient,” Weiland said.

If health professionals find a significant problem with a patient swallowing, they can refer the patient for treatment. Some common examples of problems include the natural deterioration of the muscles, which can be strengthened through electrical exercise.

“A major way to do this is called neuromuscular electrical stimulation, where we attach the electrodes to the swallowing muscles and contract them through the stimulation,” Welland said, adding that some oral motor exercises with the help of the electrodes can help strengthen the target muscles.

Assessments are covered by Medicare, as patients who require a FEES assessment tend to be older. However, Weiland explained that most commercial insurances also cover it with a co-pay, because the evaluation is not limited to older patients.

Weiland said that while Mitchell is one of the first Avera properties to receive a FEES machine, expansions are planned at Avera McKennan in Sioux Falls this year. The technology could also expand to other Avera locations in the coming years.