Speech-Language Pathology

Impact of COVID-19 Pandemic on Number of Patients Receiving Instrumental Swallow Evaluations

A major role of the medical speech language pathologist (SLP) is the assessment and treatment of oropharyngeal dysphagia. Typically, assessment is initially conducted clinically, which allows the SLP to determine risk for oropharyngeal dysphagia and aspiration. A clinical evaluation is often sufficient to diagnose oral dysphagia; however, pharyngeal dysphagia and aspiration can only be directly visualized through an instrumental assessment.¹⁻³

There are 2 types of instrumental swallow evaluations that are utilized in standard practice. The first, videofluoroscopic swallow study (VFSS), also known as modified barium swallow (MBS) or oropharyngeal motility study (OPMS), uses continuous fluoroscopy to observe bolus motility from the lips to the esophagus. This assessment has been most commonly used for both the Head & Neck Institute’s inpatient and outpatient populations for many years. The second, a flexible/fiberoptic endoscopic evaluation of swallowing (FEES), uses a flexible endoscope to directly observe the upper airway during swallowing tasks. While this assessment was available to patients, limitations on equipment and training resulted in minimal use of this assessment prior to 2019.

Number of Patients Who Underwent Instrumental Swallow Evaluations

2019 - 2020

In January 2019, the Head & Neck Institute purchased a new mobile swallowing workstation that allowed FEES to be more accessible to patients.

During 2019, a gradual increase in referrals and use of FEES was seen and institute practitioners hypothesized that the new equipment would increase overall referrals for instrumental swallow evaluations, as it would allow patients unable to travel to the radiology department or unable to safely consume barium to undergo an evaluation. Unfortunately, when the COVID-19 pandemic hit in the spring of 2020, use of the assessment dropped due to concerns about choosing an AGP (aerosolizing generating procedure) in patients with unknown or positive COVID status.

Type of Instrumental Swallow Evaluation Completed

2019 - 2020

FEES = fiberoptic endoscopic evaluation of swallowing,
VFSS = videofluoroscopic swallow study

As the data above demonstrates, a decrease was seen in both assessments for inpatients and outpatients in 2020 compared with 2019. The decrease in patients served is attributed to the COVID-19 pandemic, including reduced outpatient visits and temporary postponement of elective procedures resulting in reduced inpatient referrals. As testing for the virus became more accessible and an understanding of precautions to prevent the spread of the virus improved, institute use of FEES has increased again. The expectation is to reach even more patients through a combination of these 2 assessment methods.