Best of five
- A. Pure-tone audiometry
- B. Fibreoptic endoscopic evaluation of swallowing (FEES)
- C. Barium swallow alone
- D. Chest radiography alone
- E. Routine laryngoscopy without test boluses
FRCS (ORL-HNS) · SECTION 1 SBA
Silent aspiration after chemoradiotherapy
A patient treated with chemoradiotherapy for oropharyngeal cancer has weight loss and recurrent chest infections but reports no cough during meals. Which test most directly evaluates pharyngeal secretions, residue and laryngeal penetration at bedside?
B. Fibreoptic endoscopic evaluation of swallowing (FEES)
FEES provides direct repeated visual assessment of pharyngeal secretion management, residue and penetration/aspiration before and after the white-out period; it supports targeted swallowing management in an at-risk patient.
Why every option is right or wrong
A. Pure-tone audiometry: This does not assess swallowing.
B. Fibreoptic endoscopic evaluation of swallowing (FEES): FEES provides direct repeated visual assessment of pharyngeal secretion management, residue and penetration/aspiration before and after the white-out period; it supports targeted swallowing management in an at-risk patient.
C. Barium swallow alone: This primarily evaluates structural oesophageal transit and is not the same as dynamic pharyngeal assessment.
D. Chest radiography alone: This may show consequences but not the swallowing mechanism.
E. Routine laryngoscopy without test boluses: An anatomical inspection alone does not provide a functional swallow assessment.
What if the scenario changed?
If oral and upper-oesophageal phase timing required quantified dynamic assessment, videofluoroscopy might be preferable.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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