Evaluation of the Whiteout During Fiberoptic Endoscopic Evaluation of Swallowing and Examination of Its Correlation with Pharyngeal Residue and Aspiration

To evaluate the whiteout duration (WO_d) and intensity (WO_i) during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and examine their correlation with each other and age, gender, bolus consistencies, residue, and aspiration. Retrospective review of 75 videorecorded FEES. The first swallow of each of the following were scored: “Empty” swallow, semisolids, solids, and liquids (International dysphagia diet standardization initiative (IDDSI) 4, 7, 0, respectively). Data scored for each swallow included WO_d, WO_i, Penetration and aspiration scale (PAS), Pharyngeal residue (Yale Pharyngeal Residue Severity Rating Scale, YPR-SRS), and saliva pooling (Murray Secretion scale, MSS). The highest PAS and YPR-SRS for each consistency during the entire examination were also collected. WO_d was significantly longer for stronger WO_i in IDDSI4 swallows (p = 0.019). WO_i was weaker for IDDSI0 swallows compared to IDDSI7, IDDSI4, and empty swallows (p < 0.05). Patients with saliva pooling had significantly shorter WO_d (0.81 ± 0.3 s for MSS = 0 vs. 0.62 ± 0.24 for MSS = 3, p = 0.04). Lower WO_i was associated with higher mean age for IDDSI0 (mean ages of 73 ± 12, 64 ± 14, 73 ± 7, 59 ± 16 years for intensity levels 1–4 respectively, p = 0.019). Swallows with weaker WO_i and longer WO_d had significantly more aspirations in IDDSI7 (28.8% of PAS ≥ 6 for intensity 2 vs 0% for intensity 4, p = 0.003 and 0.77 ± 0.4 s for PAS 1–2 vs. 1.02 ± 0.08 for PAS 6–8, p = 0.049). WO_i and WO_d are significantly associated with each other. WO_i may vary for different bolus consistencies and decreases with age. Longer WO_d and weaker WO_i are associated with penetration–aspiration. Shorter WO_d is associated with saliva pooling.