(727) Surveillance Yield of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) for Post-Intubation Acute Laryngeal Injury

Introduction: Acute laryngeal injury (ALgI) has high prevalence in patients with prolonged intubation and can lead to development of laryngotracheal stenosis. Fiberoptic endoscopic evaluation of swallowing (FEES) is frequently performed by speech-language pathologists (SLPs) and may identify abnormalities that prompt otolaryngology consultation, though surveillance role in ALgI is currently unclear. This study evaluated yield of inpatient FEES in identifying laryngeal abnormalities consistent with ALgI.

Methods: A retrospective cohort study was conducted of 492 hospitalized patients undergoing inpatient FEES between July 2022 and June 2024. Inclusion criteria included endotracheal intubation and inpatient or outpatient otolaryngology consultation prompted by FEES. Demographic, hospitalization, and endoscopic data were extracted. ALgI was defined by objective endoscopic criteria.

Results: A total of 53 patients met inclusion criteria and underwent flexible laryngoscopy. 34 (64.2%) had evidence of ALgI. Explicit SLP recommendation for otolaryngology consult was associated with higher odds of ALgI (OR 3.69; p=0.09). Median intubation duration was 4.8 days. Time from extubation to otolaryngology evaluation did not differ by ALgI status (3.9 ± 3.4 vs 4.1 ± 3.1 days; p = 0.88). Specific FEES findings of laryngeal edema (72.7% vs 58.1%; OR 1.93; p=0.27) and vocal fold motion abnormalities (67.4% vs 42.9%; OR 2.76; p=0.21) trended towards higher ALgI rates, though not statistically significant. Presence of a posterior laryngeal abnormality on FEES was not associated with ALgI (66.7 vs 60%; OR 1.33; p=0.62).

Conclusions: Over three in five patients referred to otolaryngology after FEES demonstrated evidence of ALgI on flexible laryngoscopy evaluation. These findings support the potential FEES as a surveillance tool for early ALgI detection and prevention of laryngotracheal stenosis. Standardized assessment to include identification of laryngeal changes that may suggest ALgI within FEES protocols may improve identification of patients requiring otolaryngologic care.