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Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), or laryngopharyngeal sensory testing, is a technique used to directly examine motor and sensory functions of swallowing so that proper treatment can be given to patients with swallowing difficulties to decrease their risk of aspiration (food and liquids going into the lungs instead of the stomach) and choking. FEESST was invented by Dr. Jonathan E. Aviv MD, FACS in 1993,〔Aviv JE, Martin JH, Keen MS, Debell M, Blitzer A. Air-pulse quantification of supraglottic and pharyngeal sensation: a new technique. Ann Otol Rhinol Laryngol 1993; 102: 777-780.〕 and has been used by otolaryngologists (ear, nose and throat doctors),〔Ulualp S Brown A, Sanghavi R, Rivera-Sanchez Y. Assessment of laryngopharyngeal sensation in children with dysphagia. Laryngoscope. 2013 Sep;123(9):2291-5.〕 pulmonologists (lung doctors),〔Phua SY, McGarvey LPA, Ngu MC, Ing AJ. Patients with gastro-oesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity Thorax 2005; 60:488-491.〕 gastroenterologists (stomach and digestion doctors),〔Aviv JE, Johnson LF. Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) to diagnose and manage patients with pharyngeal dysphagia. Practical Gastro 2000; 24: 52-59.〕 intensivists (intensive care specialists)〔Clayton NA, Carnaby-Mann GD, Peters MJ, Ing AJ. The effect of chronic obstructive pulmonary disease on laryngopharyngeal sensitivity. Ear Nose Throat J. 2012 Sep;91(9):370-382.〕 and speech-language pathologists 〔Setzen M, Cohen MA, Mattucci KF, Perlman PW, Ditkoff MK. Laryngopharyngeal sensory deficits as a predictor of aspiration. Oto Head Neck Surg 2001; 124: 622-624.〕 for the past 20 years. Swallowing consists of two distinct but interrelated processes: 1. Moving food and liquids from the mouth into the stomach through a set of coordinated muscle movements of the mouth larynx, pharynx and the esophagus 2. Protecting the airway to prevent food and liquids from entering the lungs.〔Zamir Z, Ren J, Hogan W, Shaker R. Coordination of deglutitive vocal cord closure and oral-pharyngeal swallowing events in the elderly. European J Gastro Hepatol 1996; 8: 425-429.〕 This natural process of swallowing can be disrupted in many ways. The problem can occur when the movements involved in swallowing are restricted due to a tumor, any type of blockage, or paralysis after a stroke. Besides the motor problems, swallowing can be impaired due to sensory dysfunction, meaning when sensation (the ability to feel) is lost or reduced anywhere in the throat area. The loss of sensation can be caused by a problem originating in the brain, such as what happens after certain types of stroke, or it can be a result of a nerve injury or swelling in the actual throat area. FEESST is the only test currently available which can identify if there is any loss of sensation in the throat area. Before FEESST was invented, all tests of swallowing, be they X-ray based tests (Modified Barium Swallow (MBS)〔Brady S, Donzelli J. The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol Clin North Am. 2013 Dec;46(6):1009-22〕 or endoscopy-based tests (Fiberoptic Endoscopic Evaluation of Swallowing (FEES)〔Logemann, J. Role of the Modified Barium Swallow in Management of Patients with Dysphagia. Otolaryngol Head Neck Surg 1997;116: 335-338.〕〔Bastian RW. Videoendoscopic evaluation of patients with dysphagia: An adjunct to modified barium swallow. Otolaryngol Head Neck Surg 1991; 104: 339-350.〕 solely looked at the motor component of swallowing without examining the sensory aspect of a swallow or the ability to feel. == Technique == FEESST is an outpatient procedure involving the passing of a thin flexible scope through the nose to the pharynx. The exam consisting of two parts. First part assesses sensation in the pharynx and airway protection. The airway protection is assessed by sending air-pulses to the throat area that is innervated by the vagus nerve, which is the region of the throat between the top of the vocal folds to the tip of the epiglottis in order to stimulate an airway protective reflex called the laryngeal adductor reflex (LAR). This reflex, which occurs when the tissues of the throat are stimulated, causes the vocal folds to close in order to protect the airway from food going into the lungs. Since the windpipe (trachea) is located so close to the food-pipe (esophagus) this is a critical reflex to be functioning well at all times. Stimulation of this reflex not only results in protection of the airway, it also initiates a swallow. When a swallow is initiated the larynx rises up to two inches, going further away from the esophagus, thereby acting as an additional cover for the airway. During the air pulse administration part of the test it is determined if the reflex (LAR) that initiates the swallow is being responsive enough. The responsiveness depends on the ability of the vagus nerve to feel so that it can properly send the impulse to the brain to initiate the LAR. If there is any injury or swelling of the vagus nerve, the sensation will be diminished. As a result the reflex responsible for protecting the airway will be affected. During sensory testing it has been shown that a much stronger stimulus is necessary to elicit the LAR if there is any desensitization to the vagus nerve. The second part of the FEESST test involves giving food to the patient and tracking where the food travels in the throat region. Green food coloring is typically given in the food to track the food as it travels along the natural pink-colored tissues of the throat. If the food that is given is seen to stick to on one side of the throat, which is called food “residue”, that usually means that there is lack of sensation or possibly even a motor/movement problem on that particular side of the throat. The treatment for this discovered throat numbness is to then teach the patient to turn their head to the numb side of their throat when they swallow. This maneuver, called a "head turn" effectively closes off the numb side of the throat so when they swallow the food is only exposed to the normal side of the throat, thereby insuring a safer swallow (on the normal side there is no residue so there is no chance of the residue accidentally falling into the vocal folds and then into the lungs (aspiration). 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Flexible Endoscopic Evaluation of Swallowing with Sensory Testing」の詳細全文を読む スポンサード リンク
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