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Flashcards in Endoscopy Deck (81)
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1

Three basic procedures for SLPs

VP Endoscopy for speech
Laryngeal stroboscopy
FEES

2

1992: ASHA first addressed endoscopy

Vocal tract visualization and imaging for the purpose of diagnosing and treating patients with voice and resonance disorders (doesn't mean swallowing)

3

Pannbacker et al., 1993

survey asking SLPS found a large portion did not think SLPs should perform nasopharyngoscopy

4

Joint Position Statement 1998

- Physicians only ones qualified in medically diagnoses related to the ID of laryngeal pathology as it affects voice
- SLPs with expertise in voice disorders and specialized training could use strobovideolaryngoscopy to ASSESS voice production and vocal function

5

Position statement 1999 (ASHA and AAO)

states that SLPs are qualified for swallow endocopy

(they later retracted that statement and now say SLPs should not do endoscopy

6

ASHA Position Statement (2008)

SLPs with specialized training in flexible/nasal endoscopy, rigid/oral endoscopy, and/or stroboscopy use these tools for the purpose of evaluated and treating disorders of speech, voice, resonance, and swallow function.

7

Virginia board of Audiology and Speech Language Pathology (June 3, 2010)

SLPs cannot perform FEES unless properly trained and in the presence of a physician (retracted a few months later)

8

State Laws that Address Endoscopy

federal government doesn't pass laws about endoscopy (it's up to the state)
- there are around 17 states that address endoscopy in their laws

9

ASHA Code of Ethics

Individuals shall engage in only those aspects of the profession that are within the scope of their professional practice and competence, considering their level of education, training, and experience

10

NRS 637B - Nevada Revised Statute

defined the practice of speech pathology
1. Prevention, screening,consultation, assessment, diagnostic, dx, counseling, collaboration and referral services
2. AAC
3. auditory training, speech reading, speech and language intervention secondary to HL
4. screening hearing
5. vocal tract imaging and visualization by oral/nasal endoscopy
6. Selecting, fitting and establishing effective use of prosthetic/adaptive devices for communication
7. Providing services to modify or enhance communication

11

ASHA Code of Ethics

Need to be practicing within scope of practice and competence considering their level of education, training, and experience

12

Medicare and other payers

- Medicare does not pay SLP directly for endoscopy in some states
- Most other insurance companies do
- Reimbursement varies by region, facility, payer
- insurance rules do not restrict your practice
(you can do anything within your scope of practice no matter what insurance covers)

13

MAC's

reimbursement from medicare

Nevadas: Palmetto GBA
- doesn't pay us directly.
- we bill them for something other than endoscopy and we end up getting paid anyway.

14

A Model Curriculum for VES (what you need to know)

1. Rationale for performing VES
2. Normal and disordered anatomy
3. endoscopic equipment and technique
4. patient safety
5. Interpreting and Reviewing images
6. Reporting
7. performing the procedure

15

1. Rationale

why are you doing the procedure
- just because you can do it doesn't mean you should
- if you already know what's wrong and you aren't going to learn anything from it, there is no reason to do it

16

2. Normal and disordered anatomy

obtained through M.S. degree course work

17

3. Endoscopic equipment and technique

endoscope
light source
camera
video storage
defogger
Misc: gloves, eye wear, lubricant, mask (decongestants, topicals)

18

4. Patient Safety

Anesthetics
- dosage should not be an issue
- some use topical anesthetics in the nose or spray in the mouth
- hospitals use nasal anesthetics prepared by pharmacy before hand with correct dosage for client

- anaphylaxis could be an issue
- allergic reaction to anesthetic
- about 100,000 cases reported annually in US
- about 1% are fatal (1,000)

Topical Anesthesia
- found in many OTC drugs (most people are exposed very early in life)
- first time (child building antibodies - no reaction)
- second time - reaction
5 year old (50lbs) = 1/3 teaspoon
adult = 1 tablespoon
0verdose isn't really an issue

Topical Sprays
- benzocaine - may cause methemoglobinemia or interference with binding of O2 to hemoglobin (could faint/die)
- rare condition, possibly dose related

Disclosure/Consent form
- nature of proposed procedure
- reason the procedure is recommended
- benefits of the procedure
- risks and complications and frequency
- alternatives to the procedure (if possible)

Contraindications
- why would you decide not to do the procedure?
pt doesn't sign consent form
pt voices objection
use of anti-coagulant/blood thinning meds
hx of bleeding disorder (nasal)

19

Recent double blind study related to children and endoscopy

no signifiant difference in the discomfort experienced by children undergoing flexible nasendoscopy after placebo, decongestant, or topical anesthetic with decongestant

20

5. Interpreting and Reviwing Images

- different for each of the three types of exams

21

6. Reporting

summarize and synthesize history, perceptual judgment, acoutic and aerodynamic measures, and endoscopy

22

7. Performing the Procedure

- didactic learning experiences
- mentoring: one-on-one
- supervised experience
- video review
- individual practice

23

Flexible Endoscopy Parts

1. Objective lens: eye piece
- look through if you don't have camera

2. Diopter adjustment ring:
- adapts the endoscope at the level of the camera
- under the eyepiece is the focus ring
(focus before focusing camera)

3. Angulator lever: Angulator
- top of the endoscope
- moves the tip
- angulates the tip
- lever used to move tip of endoscope
- navigate small cavity

4. Cable for the light source: has a metal tip
- adapted to the light source
- plugged into the light source
- May need adaptor depending on which endoscope you use

5. Insertion tube
- "hose" near the tip of the endoscope
- this section of the scope is mobile
- end of the insertion tube: distal tip - make sure it's always clean. This is where the light source comes from.

24

Rigid Oral Endoscope

- eye piece
- camera adaptor/lens (click onto eye piece)
- attach to light source

Different degrees: 70 and 90
(we typically use 70 degree) - tip of endoscope doesn't have to go as far into oropharynx
- depth of penetration into the oral cavity is less invasive

90 degree - shoots light at 90 degrees, tip of scope has to be almost touching posterior pharyngeal wall (don't have in our clinic)

25

Components of stroboscopic system

Monitor
- where you see the exams
- on the cart
- on the wall (so patient can see)
- sometimes helps in pediatrics to see

Footswitch
- can use with Xenon and Halogen
- record switch
- switch allows clinician to look at the video strobe
(fast mode, slow mode, locked)
- can freeze frames

Digital camera
- camera, lens, lens adapter
-comes in 1 chip and 3 chip (higher is better resolution) - clinic has 3 chip

Printer
- on bottom half
- allows examiner to go through recording and capture a snap shot
- incorporate into a document
- can be sent to referring practicioner

Keyboard
- user friendly, reliable

acoustic microphone
- picks up ambient noise
- mounted on camera
- relatively stable microphone mouth to distance
- external speakers sit next to monitor

halogen/xenon light
150 watts

CPU
- hard drive, storage and retrieval, own software system and cataloging, allows playback, slow motion, regular speed, fast frame, frame by frame analysis, software is user friendly, storage for digital strobe

Microphone (laryngeal)
- plugs into light source
- contact microphone: held firmly against neck
- allows synchronization of intermittent light source and voice
- contact microphone allows for stroposcopic image

Lens adaptor
- adapts the eye piece of the endoscope

26

types of light source

Continuous - always on
Intermittent - bulb is on and off

27

types of bulbs

Halogen

Xenon

28

Halogen bulb

yellow light source, inexpensive, not as bright as Xenon, only comes in continuous light source

Advantage: less expensive

150 Watts
- accomodates for this type of bulb wattage
option of 300 W (used in high speed imaging)
- 300W only type used for high speed imaging
- 300W cannot be used with fiberoptic endoscope: gets very hot and could burn patient

29

Xenon bulb

- very bright
- white light
- bulbs are very expensive - $68 per use
- intermittent xenon used in stroboscopy
- light is on and off
- synchronizes with fundamental frequency of voice - that is how xenon knows th epulse
- intermittent light source typically 150 W

30

types of scopes

rigid and flexible

light source plugs into the endoscope table...use adaptors to adapts the various scopes and light source
chip on the tip - has own light source