(1/5) Great new publication in Dysphagia that contributes to our understanding of the sensitivity of FEES and VFSS in detecting airway invasion. Interested in how this may impact your standard FEES protocol? See my thoughts below. https://twitter.com/Official_DRS/status/1199692568256110593

(2/5) The majority of previously published research comparing simultaneous FEES and VFSS provides strong evidence suggesting that FEES may be more sensitive than VFSS for detecting airway invasion. This study, however, found the opposite. Why the discrepancy?

(3/5) One potential explanation is that previously published studies used barium as the radiopaque contrast. Barium possesses a "coating effect" which is hypothesized to enhance the detection of airway invasion during FEES (see link). https://lshss.pubs.asha.org/doi/abs/10.1044/2018_AJSLP-18-0119

(4/5) The current study used iopamidol, rather than barium, as the radiopaque contrast. Iopamidol is a clear water-soluble contrast that does not possess a coating effect. If you have access to the full article in Dysphagia, consider viewing their supplemental videos.

(5/5) When synthesizing this body of literature, one potential take-away is that FEES may be more sensitive than VFSS when detecting airway invasion if using a contrast agent that coats the mucosa (e.g., barium) but may be less sensitive than VFSS if this is not used.

@swallowstudySLP - Saw you tweet about this article and thought you might be interested in hearing my two cents