Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?

We aimed to investigate whether the type of dysphagia examination (fiberoptic endoscopic evaluation of swallowing [FEES] or videofluoroscopy) influences the scoring of penetration and aspiration. Prospective, single-blind study. Fifteen dysphagic participants were recruited and underwent one FEES and one videofluoroscopy examination, performed and recorded simultaneously. Fifteen independent raters from 12 centers scored penetration and aspiration from recordings using the Penetration Aspiration Scale. Raters were blind to participant details, the pairing of the FEES and videofluoroscopy recordings, and the other raters' scores. Interrater and intrarater reliability were analyzed using weighted kappa. The Penetration Aspiration Scale scores were significantly higher for the FEES recordings than for the videofluoroscopy recordings (ANOVA P < .001). The mean difference between the FEES and videofluoroscopy penetration aspiration scores for the same swallows was 1.15 points. Interrater and intrarater reliability ranged from 0.64 to 0.79 (weighted kappa). Penetration aspiration is perceived to be greater (more severe) from FEES than videofluoroscopy images. The clinical implications are discussed.