Steven B. Leder

This text is a reliable, validated, anatomically defined, and image-based tool to determine residue location and severity when performing fiberoptic endoscopic evaluation of swallowing (FEES). Based upon research by Drs. Leder and Neubauer, an easily interpreted, readily learned, and hierarchically organized pharyngeal residue severity rating scale was developed for speech-language pathologists, otolaryngologists, and other health care professionals who perform and interpret FEES. The Yale Pharyngeal Residue Severity Rating Scale works equally well for any swallow of interest, whether it is the first, subsequent clearing, or last swallow. The endoscopist simply has to match their chosen swallow with its scale mate. The Yale Pharyngeal Residue Severity Rating Scale can be used for both clinical advantages and research opportunities. Clinically, clinicians can now accurately classify vallecula and pyriform sinus residue severity as none, trace, mild, moderate, or severe for diagnostic purposes, determination of functional therapeutic change, and precise dissemination of shared information. Research uses include tracking outcomes for clinical trials, investigating various swallowing interventions, demonstrating efficacy of specific interventions to reduce pharyngeal residue, determining morbidity and mortality associated with pharyngeal residue in different patient populations, and improving the training and accuracy of FEES interpretation by students and clinicians. The Yale Pharyngeal Residue Severity Rating Scale is an important addition to the deglutologist’s tool box.

The Yale Swallow Protocol is an evidence-based protocol that is the only screening instrument that both identifies aspiration risk and, when passed, is able to recommend specific oral diets without the need for further instrumental dysphagia testing. Based upon research by Drs. Steven B. Leder and Debra M. Suiter, an easily administered, reliable and validated swallow screening protocol was developed and can be used by speech-language pathologists, nurses, otolaryngologists, oncologists, neurologists, intensivists and physicians assistants. In addition, the protocol can be used in a variety of environments, including acute care, rehabilitation and nursing homes. The Yale Swallow Protocol meets all of the criteria necessary for a successful screening test, including being simple to administer, cross-disciplinary, cost effective, acceptable to patients and able to identify the target attribute by giving a positive finding when aspiration risk is present and a negative finding when aspiration risk is absent. Additionally, early and accurate identification of aspiration risk can significantly reduce health-care costs associated with recognized prandial aspiration.