As onsite dysphagia imaging providers, we occasionally come across findings that warrant outside referrals. FEES has the benefit of examining a patient’s laryngeal and pharyngeal mucosa and because of this, we are often the first to identify laryngeal and pharyngeal abnormalities. In a study by Pazak and colleagues published in 2021, there were 75 patients seen in a community hospital for FEES due to swallowing complaints, and 29 of those patients had laryngeal pathologies and were referred to ENT. The ENT examination revealed that of these 29 patients, there were a range of diagnoses such as fungal laryngitis, hemorrhage, granuloma, and one patient was identified to have an early glottic cancer. 

The ability to discern between normal variants and abnormalities that require further consultation is a skill that has been demonstrated by the Pazak study. We set out to gather data to see if the same results apply in the post-acute/long term care settings. Our purpose was to describe how FEES exams can be useful in identifying pharyngeal and laryngeal abnormalities, as well as describe the challenges associated with residents receiving ACS (ambulatory care service), such as ENT. 

Over the course of nine months, three of our seasoned SLPs performed 1,003 FEES. They collected information on the residents who were recommended for ENT and completed follow-up via phone call or text to the referring clinician asking the following questions: 

  1. Has the ENT consult been scheduled/requested by the facility?
  2. Were there barriers to scheduling?
  3. If no appointment has been made, what is the reason?
  4. If scheduled for ENT, what was the appointment date and general ENT findings?

Our hypotheses was that seasoned SLPs can identify abnormal pharyngeal and laryngeal anatomy on FEES; however, residents rarely receive outside consultations when recommended. 

What do you think happened? Want to find out? Join Jackie Staley, M.A., CCC-SLP and Vanessa Lauf, M.S., CCC-SLP, BCS-S at the ASHA Convention in Boston. The Poster Session (8124L) titled Frequency of ENT Referral Following Incidental Laryngeal Findings on Bedside FEES in Skilled Nursing Facilities will be on Thursday, November 16, 2023, from 2:30 to 4 pm!