Dr.Unnikrishnan Menon, Assistant Professor in the Department of ENT at the Amrita School of Medicine was recently awarded the best poster award at the 6th Phonosurgery Conference and Swallowing Disorders Symposium in Bombay Hospital, Mumbai. His poster was titled Utility of FEES in Stroke Cases.

FEES or Flexible Endoscopic Evaluation of Swallowing is a useful test to evaluate the swallowing mechanism. Dr. Unnikrishnan’s poster depicted the benefits of FEES in determining the whether oral feeding is possible in one who has suffered a stroke.

“A majority of stroke patients have difficulty swallowing. Most of the time, this goes away in due course, but until then food has to be given through a naso-gastric tube. This can be removed once the doctor, either a neurologist or a swallowing therapist, is sure that the patient can take food orally without problems,” stated Dr. Unnikrishnan.

Cautioning that stroke patients might have difficulty regaining their swallowing function sometimes, he said that such patients might cough while attempting to swallow. If bedside clinical examination cannot identify the problem, FEES is needed. The doctor explained the procedure.

“In FEES, a flexible scope is passed through the nose down to the area where the windpipe (larynx) and the foodpipe (cricopharynx) start. These areas can now be clearly seen. This test allows examiners to directly observe the movement of the food from the back of the mouth through the throat, and into the esophagus. This helps determine whether the patient can swallow without difficulty, which in turn helps decide whether the patient can be given oral feeds.”

In his poster, Dr. Unnikrishnan presented five case studies from Amrita where FEES helped in deciding the issue of swallowing. In four patients who suffered from lateral medullary stroke, middle cerebral artery infarct, cerebellar stroke and basilar ganglia stroke, respectively, FEES helped confirm that the naso-gastric tube could be removed.

In the case of one patient, with medullary stroke, naso-gastric tube feed was continued.

“FEES has been used as a method of studying swallowing difficulties for almost a decade in the West. In India, however, it is relatively new. We started doing this procedure at Amrita from January 2010 on. My poster was invited by the symposium organizers, so that others in India could also learn,” he explained further.

Dr. Unnikrishnan received training in FEES under the guidance of Dr. Jayakumar, veteran swallowing therapist and visiting faculty of Swallowing Clinic in the Department of Head and Neck Surgery at Amrita. He had also received the Best Paper Award for the same study at the National PhonoCon in Guwahati in February 2012. We congratulate Dr. Unnikrishnan Menon for his achievement.

September 21, 2012
School of Medicine, Kochi