Background Dysphagia is a common problem in Huntington's disease (HD) that requires attention and adequate management. Instrumental assessments to visualise the structure and functions of the different stages of swallowing and to identify the risk of aspiration include Videofluoroscopic evaluation or Fiberoptic Endoscopic Evaluation of Swallowing (FEES). In HD, there is no report on the evaluation of dysphagia by FEES so far.
Methods FEES was performed at the bedside or in the outpatient clinic with a flexible fiberoptic rhinolaryngoscope in 23 HD patients (11 f/12 m; 23–74 years) in different disease stages (stage I: n=5; II: n=4; III: n=6; IV: n=8). Dysphagia was assumed in all patients due to known feeding/swallowing history and clinical swallowing assessment. After pre-swallow evaluation of both anatomy and physiology and the presence of pooled retentions in the larynx or the trachea, puree boluses were given, followed by liquids and solid boluses.
Results Disturbances of the pre-oral, oral, and pharyngeal stage of swallowing were found in 19 of 23 patients at all stages of HD. Ten of these patients presented pharyngeal dysphagia with aspiration or risk of aspiration (stage II: n=1; III: n=4; IV: n=5) and a feeding tube was recommended in a sensitive discussion with patients and carers; four patients decided in favour of this intervention, six patients refused tube feeding.
Conclusion Although FEES does not allow visualisation of the oral stage of swallowing, one advantage of FEES in comparison to a videofluoroscopic evaluation is that chorea has only little influence on the view of the pharynx and larynx during the examination because the flexible endoscope adapts well in the pharynx to involuntary movements of the patients. Evaluation of HD-related dysphagia by FEES was successful in assessing pre-swallow physiology, identifying pharyngeal dysphagia, and providing objective data for individualised therapeutic interventions.
- fiberoptic evaluation
- feeding tube