Discrepant Results of Flexible Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopy Swallowing Study (VFSS) in Myasthenia Gravis’ Patient

Authors

  • Susyana Tamin Departemen Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala dan Leher, Fakultas Kedokteran, Universitas Indonesia
  • Devianty Octavia Departemen Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala dan Leher, Fakultas Kedokteran, Universitas Indonesia

DOI:

https://doi.org/10.33533/jpm.v18i1.7942

Keywords:

Dysphagia, Myasthenia gravis, VFSS, FEES, Flexible Endoscopic Evaluation of Swallowing, Videofluoroscopy Swallowing Study

Abstract

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that causes weakness in skeletal muscles. Dysphagia is an early symptom that is often found in 6-15% of patients with myasthenia gravis. Flexible Endoscopic Evaluation of Swallowing (FEES) and Video Fluoroscopic Swallowing Study (VFSS) examinations are routinely used to diagnose dysphagia. This paper reports a case of  Male, 51 years old diagnosed with neurogenic oropharyngeal dysphagia due to MG. Swallowing evaluation post-therapy and rehabilitation programs were carried out. Interestingly both FEES and VFSS had a significant discrepant result. In cases of dysphagia due to MG, when interpreting objective swallowing function examination, confounding factors such as fatigue, timing of examinations, and time of taking medication specifically anticholinesterase (Pyridostigmine), should be taken into consideration.

References

Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, et al. Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology. Neurol Res Pract. 2021;3(1):23. DOI: https://doi.org/10.1186/s42466-021-00122-3

Farrugia ME, Goodfellow JA. A practical approach to managing patients with myasthenia gravis—opinions and a review of the literature. Front Neurol. 2020;11:604. DOI: https://doi.org/10.3389/fneur.2020.00604

Haryono A, Budiarti R, Muyassaroh. Dysphagia as presenting symptom of myasthenia gravis: a case series of successful outcome in a multidisciplinary approach. J Med Sci. 2020;52(3):282-91. DOI: https://doi.org/10.19106/JMedSci005203202010

Umay EK, Karaahmet F, Gurcay E, Balli F, Ozturk E, Karaahmet O, et al. Dysphagia in myasthenia gravis: the tip of the Iceberg. Acta Neurol Belg. 2018;118(2):259-66. DOI: https://doi.org/10.1007/s13760-018-0884-1

Sridharan SS, Lazarus CL, Amin MR. Nonsurgical Management of Swallowing Disorders. In: Johnson JT, Rosen CA. (eds.) Bailey’s Head & Neck Surgery Otolaryngology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2014. p.838—51. DOI: https://doi.org/10.1177/0194599814541403

Ramalho S, Pereira S, Oliveira P, Morais H, Lima N, Conde A. Dysphagia as a presenting symptom of myasthenia gravis: case report. Int J Otolaryngol Head Neck Surg. 2014;3:23–5. DOI:

https://doi.org/10.4236/ijohns.2014.31005

Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100(8):678-81. DOI: https://doi.org/10.1177/000348949110000815

Warnecke T, Dziewas R, Langmore S. Neurogenic Dysphagia. Switzerland: Springer; 2021. p88-9. DOI: https://doi.org/10.1007/978-3-030-42140-3

Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, Bastidas AR, Garcia R, Ovalle S, et al. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope. 2017;127(9):2002-10. DOI: https://doi.org/10.1002/lary.26419

Fattori B, Giusti P, Mancini V, Grosso M, Barillari MR, Bastiani L, et al. Comparison between videofluoroscopy, fiberoptic endoscopy, and scintigraphy for diagnosis of oropharyngeal dysphagia. Acta Otorhinolaryngol Ital. 2016;36(5):395-402. DOI: https://doi.org/10.14639%2F0392-100X-829

Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 2008;19(4):769-85. DOI: https://doi.org/10.1016/j.pmr.2008.06.004

Belafsky PC, Kuhn MA. The Clinician’s Guide to Swallowing Fluoroscopy. The Clinician’s Guide to Swallowing Fluoroscopy. New York: Springer; 2014. DOI: https://doi.org/10.1007/978-1-4939-1109-7

Kelly AM, Leslie P, Beale T, Payten C, Drinnan MJ. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity. Clin Otolaryngol. 2006;31(5):425-32. DOI: https://doi.org/10.1111/j.1749-4486.2006.01292.x

Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107(3):396-401. DOI: https://doi.org/10.1097/00005537-199703000-00023

Scharitzer M, Roesner I, Pokieser P, Weber M, Denk-Linnert DM. Simultaneous radiological and fiberendoscopic evaluation of swallowing (“SIRFES”) in patients after surgery of oropharyngeal/laryngeal cancer and postoperative dysphagia. Dysphagia. 2019;34(6):852-61. DOI: https://doi.org/10.1007/s00455-019-09979-8

Edge R, Argáez C. CADTH RAPID RESPONSE REPORT: SUMMARY WITH CRITICAL APPRAISAL Fibreoptic Endoscope Evaluation versus Video Fluoroscopic Swallowing Exams for Patients with Dysphagia: A Review of Diagnostic Accuracy and Cost-Effectiveness. 2019 Nov. p.1—18. Available from: https://www.cadth.ca/sites/default/files/pdf/htis/2019/RC1213%20FEES%20vs%20VFSS%20Final.pdf

Llabrés M, Molina-Martinez FJ, Miralles F. Dysphagia as the sole manifestation of myasthenia gravis. J Neurol Neurosurg Psychiatry. 2005;76(9):1297-300. DOI: https://doi.org/10.1136/jnnp.2004.038430

Linke R, Witt TN, Tatsch K. Assessment of esophageal function in patients with myasthenia gravis. J Neurol. 2003;250(5):601-6. DOI: https://doi.org/10.1007/s00415-003-1049-5

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Published

2024-06-15

How to Cite

Tamin, S., & Octavia, D. (2024). Discrepant Results of Flexible Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopy Swallowing Study (VFSS) in Myasthenia Gravis’ Patient. Jurnal Profesi Medika : Jurnal Kedokteran Dan Kesehatan, 18(1), 100–105. https://doi.org/10.33533/jpm.v18i1.7942