Best of five
- A. Chest radiograph alone
- B. Pure-tone audiometry
- C. Fibreoptic endoscopic evaluation of swallowing or videofluoroscopy selected to the clinical question
- D. Static neck CT alone
- E. Empirical tube feeding without assessment
FRCS (ORL-HNS) · SECTION 1 SBA
Aspiration after head and neck treatment
A patient has recurrent pneumonia and silent aspiration after chemoradiotherapy. Which investigation best characterises the physiology and tests compensatory strategies in real time?
C. Fibreoptic endoscopic evaluation of swallowing or videofluoroscopy selected to the clinical question
Instrumental assessment identifies residue, penetration, aspiration and response to posture or consistency changes. FEES is portable and directly views secretions; videofluoroscopy depicts bolus flow across phases.
Why every option is right or wrong
A. Chest radiograph alone: This may show consequences but not swallowing physiology.
B. Pure-tone audiometry: Hearing assessment is unrelated.
C. Fibreoptic endoscopic evaluation of swallowing or videofluoroscopy selected to the clinical question: Instrumental assessment identifies residue, penetration, aspiration and response to posture or consistency changes. FEES is portable and directly views secretions; videofluoroscopy depicts bolus flow across phases.
D. Static neck CT alone: Anatomy does not reveal dynamic bolus safety.
E. Empirical tube feeding without assessment: Nutrition may be necessary, but reversible strategies and aspiration mechanism still matter.
What if the scenario changed?
If there were acute airway obstruction or major haemorrhage, stabilisation would precede instrumental swallowing assessment.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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