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Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults.

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Title: Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults.
Authors: Curtis, James A.1,2 yrj9003@med.cornell.edu, Borders, James C.2, Dakin, Avery E.2, Troche, Michelle S.2
Source: Journal of Speech, Language & Hearing Research. Jul2023, Vol. 66 Issue 7, p2260-2277. 18p. 5 Charts, 6 Graphs.
Subject Terms: *Speech therapy, *Longitudinal method, *Adults, Reference values, Therapeutics, Deglutition, Scientific observation, Endoscopic surgery, Health outcome assessment, Vocal cords, Race, Epiglottis, Independent living, Descriptive statistics, Hypopharynx, Research funding, Statistical sampling, Endoscopy, Oropharynx
Abstract: Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)—a standard- ized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). Method: FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration–Aspiration Scale (PAS) scores, and percentage- based residue ratings for six anatomic landmarks. Secondary outcome mea- sures included sip size, bite size, and number of swallows. Results: Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue rat- ings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g sal- tine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow. Discussion: The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing out- comes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample (N = 39), with most people below the age of 60 years (n = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Speech, Language & Hearing Research is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults.
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  Data: <searchLink fieldCode="AR" term="%22Curtis%2C+James+A%2E%22">Curtis, James A.</searchLink><relatesTo>1,2</relatesTo><i> yrj9003@med.cornell.edu</i><br /><searchLink fieldCode="AR" term="%22Borders%2C+James+C%2E%22">Borders, James C.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Dakin%2C+Avery+E%2E%22">Dakin, Avery E.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Troche%2C+Michelle+S%2E%22">Troche, Michelle S.</searchLink><relatesTo>2</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+Speech%2C+Language+%26+Hearing+Research%22">Journal of Speech, Language & Hearing Research</searchLink>. Jul2023, Vol. 66 Issue 7, p2260-2277. 18p. 5 Charts, 6 Graphs.
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  Data: *<searchLink fieldCode="DE" term="%22Speech+therapy%22">Speech therapy</searchLink><br />*<searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br />*<searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Reference+values%22">Reference values</searchLink><br /><searchLink fieldCode="DE" term="%22Therapeutics%22">Therapeutics</searchLink><br /><searchLink fieldCode="DE" term="%22Deglutition%22">Deglutition</searchLink><br /><searchLink fieldCode="DE" term="%22Scientific+observation%22">Scientific observation</searchLink><br /><searchLink fieldCode="DE" term="%22Endoscopic+surgery%22">Endoscopic surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Health+outcome+assessment%22">Health outcome assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Vocal+cords%22">Vocal cords</searchLink><br /><searchLink fieldCode="DE" term="%22Race%22">Race</searchLink><br /><searchLink fieldCode="DE" term="%22Epiglottis%22">Epiglottis</searchLink><br /><searchLink fieldCode="DE" term="%22Independent+living%22">Independent living</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Hypopharynx%22">Hypopharynx</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+sampling%22">Statistical sampling</searchLink><br /><searchLink fieldCode="DE" term="%22Endoscopy%22">Endoscopy</searchLink><br /><searchLink fieldCode="DE" term="%22Oropharynx%22">Oropharynx</searchLink>
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  Label: Abstract
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  Data: Purpose: The aim of this study was to establish preliminary reference values for the Visual Analysis of Swallowing Efficiency and Safety (VASES)—a standard- ized rating methodology used to evaluate swallowing safety and efficiency for flexible endoscopic evaluation of swallowing (FEES). Method: FEES were completed in nondysphagic, community-dwelling adults using a standardized protocol of 15 swallowing trials that varied by bolus size, consistency, contrast agent, and swallowing instructions. FEES were blindly analyzed using VASES. Primary outcome measures included bolus location at swallow onset, Penetration–Aspiration Scale (PAS) scores, and percentage- based residue ratings for six anatomic landmarks. Secondary outcome mea- sures included sip size, bite size, and number of swallows. Results: Thirty-nine healthy adults completed the study, yielding an analysis of 584 swallows. Swallows were initiated with the bolus in the pharynx for 41.8% of trials. PAS 1 was the most common score, accounting for 75.3% of trials, followed by PAS 3, which accounted for 18.8% of trials. When residue was present (> 0%), the amount was relatively small across all anatomic landmarks, with median residue ratings of 2.0% (oropharynx), 1.5% (hypopharynx), 3.0% (epiglottis), 3.0% (laryngeal vestibule), and 3.5% (vocal folds). Five events of aspiration were observed, which were characterized by subglottic residue rat- ings of 1%, 3%, 10%, 24%, and 90%. The average sip size of self-selected volume cup sips of water was 19.8 ml, and the average bite size of a 3.0-g sal- tine cracker was 1.33 g. Moreover, 78% of the trials in this study protocol (except 90-ml trials) were completed in a single swallow. Discussion: The results from this study provide preliminary norms for VASES that could be used as a reference when assessing functional swallowing out- comes during FEES. While this is an important first step in establishing norms for FEES and VASES, clinicians and researchers should be mindful that the normative reference values from this study are from a relatively small study sample (N = 39), with most people below the age of 60 years (n = 30). Future research should expand on these norms by including a greater number of people across the age continuum and with greater racial, ethnic, and gender diversity. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Journal of Speech, Language & Hearing Research is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1044/2023_JSLHR-23-00132
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      – Code: eng
        Text: English
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    Subjects:
      – SubjectFull: Speech therapy
        Type: general
      – SubjectFull: Longitudinal method
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      – SubjectFull: Adults
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      – SubjectFull: Reference values
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      – SubjectFull: Statistical sampling
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      – SubjectFull: Endoscopy
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      – TitleFull: Normative Reference Values for FEES and VASES: Preliminary Data From 39 Nondysphagic, Community-Dwelling Adults.
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              Text: Jul2023
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