Detecting Aspiration With Narrow Band Imaging

Abstract

TITLE: DETECTING ASPIRATION WITH NARROW BAND IMAGING (NBI)

Authors: STANLEY Claire 1; PADDLE Paul 1, 2; GRIFFITHS Susie 1; SAFDAR Adnan1, 2; PHYLAND Debra 1, 2.

1 Department of Otolaryngology; Head & Neck Surgery, Monash Health, Clayton, Australia;
2 Department of Surgery, Monash University, Clayton, Australia

Objectives
Narrow Band Imaging (NBI) is used to improve the visualisation of abnormal tissue in endoscopy compared to white light (WL). Recently, it has been suggested that NBI light may increase the sensitivity of penetration and aspiration detection in Flexible Endoscopic Evaluation of Swallowing (FEES). Given most FEES equipment has this technology, it has been proposed as as an easy and cost effective tool to improve dysphagia evaluation, leading to more reliable interpretation of findings (Niestedt, et al. 2017). We tested this hypothesis regarding NBI technology in patients with unilateral vocal cord paralysis, as they are typically a difficult population in which to detect the presence of aspiration during FEES.

Materials & Methods
A prospective observational outcome study of 22 outpatients with unilateral vocal cord paralysis was performed. FEES using standard white light was compared to NBI for the presence of penetration and aspiration. Expert raters blinded to patient identification, clinical history, and bolus types were asked to assess digital recordings of the FEES using both light sources. Intra -rater and inter-rater reliability were calculated, rater confidence, as well as comparing EAT-10 scores, aetiology and demographic data to the presence of laryngeal penetration and aspiration.

Results
22 patients were included in the study with expert ratings across 144 test conditions (72 WL vs 72 NBI ). There was no statistical significant difference between NBI and WL in the detection of laryngeal penetration and aspiration with milk boluses. In fact, the self-rated confidence of expert clinicians was lower with the alternate light source (NBI). Further results will be discussed including demographic data, EAT-10 scores and percentage of penetration and aspiration from the sample.

Conclusion
Narrow Band Imaging (NBI) during Flexible Endoscopic Evaluation of Swallowing (FEES) did not improve the detection of laryngeal penetration or aspiration of milk in patients with unilateral vocal fold paralysis.