Retrograde fiberoptic endoscopy evaluation for patients with laryngeal edema

Abstract

Background: Airway and swallowing evaluation is a crucial step before weaning the patient from a tracheostomy tube. Different evaluation procedures can be used successfully in many patients, but sometimes, this can be difficult or impossible for patients who have laryngeal edema as the existence of edema tends to block the view of true vocal folds. Thus, a new approach using retrograde fiberoptic endoscopy evaluation of swallowing (FEES) has been suggested to help visualize the vocal folds clearly. This study was performed to evaluate the impact of such a modification to the standard FEES. Methodology: Thirty-six patients were referred for swallowing and airway evaluation. They were examined via nasopharyngolaryngobronchoscopy and FEES; nine of them had laryngeal edema and fit the inclusion criteria. Results: Four out of the nine patients who had laryngeal edema could immediately swallow after evaluation with retrograde FEES. Conclusions: Retrograde FEES is suggested to be an effective way to evaluate swallowing and is a valuable tool for research in this area. Level of evidence: Level 4 (case series).