Penetration–Aspiration: Is Their Detection in FEES® Reliable Without Video Recording?

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Abstract
Penetration–aspiration is known as the main finding in deglutition-disordered patients with implications for diagnostics and therapeutic management. Reliable detection of penetration–aspiration is given with fiberoptic endoscopic evaluation of swallowing (FEES®) as one of the gold standards in instrumental swallowing evaluation. The advice to implement video recording in FEES® to assure quality in identifying penetration–aspiration is often ignored, especially in bed-side settings. Thus, the aim of this study was to compare reliability and validity in detecting penetration–aspiration events with and without video recording. Eighty FEES® sequences, ten per severity grade of the Penetration–Aspiration Scale by Rosenbek et al., were rated by four blinded ENTs with two different methods. The first method simulated the evaluation without video recording (Method A), and the second one with video recording (Method B). Rating was performed twice per setting with 2 weeks in between and every time newly randomized. Intra- and inter-rater reliability as well as validity were analyzed for both evaluation methods. R-to-Z transformation was used to reveal the more reliable method and ordinal regression to determine potential rating influences. Method B demonstrated higher intra- and inter-rater reliability values than Method A and was revealed as more reliable in identifying penetration–aspiration according to r-to-Z transformation (Z = −2.92, p = .004). Ordinal regression detected a significant influence of the evaluation method choice on the rating results (p = .016). As Method B turned out to be more reliable than Method A in detecting penetration–aspiration, the presented study recommends the implementation of video recording in swallowing diagnostics.

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