The effect of nasal introduction of anaesthetic in adults undergoing Fibreoptic Endoscopic Evaluation of Swallowing (FEES): A systematic review protocol

The primary objective of this systematic review is to identify and synthesise the best available evidence on the effect of anaesthetic on the physiological aspects of swallowing (rate, strength, and risk of laryngeal penetration or aspiration) as well as client pain and/or discomfort in adults undergoing Fibreoptic Endoscopic Evaluation of Swallowing (FEES). This procedure is also described as Fibreoptic Endoscopic Evaluation of Swallowing with Sensory testing (FEESS or FEESST) and Videoendoscopic Evaluation of Dysphagia (VEED). Inclusion criteria Types of participants This review will consider adults (defined for the purposes of this review as being 16 years and over), regardless of gender or reason for undergoing the FEES procedure. Paediatric patients will not be considered for this review due to the challenges of conducting this procedure on this patient group including the size of the nasal passages and nasopharynx, and poor tolerance of the procedure. Participants must have no known co-morbidities that might affect the outcomes of interest (e.g. nasal surgery, deviated nasal septum, traumatic brain injury, reaction to anaesthetic, known allergies, hypertrophic turbinate, nasal scars, craniofacial disorders) Only studies involving patient clients/participants, not volunteers, will be included, as this best reflects the population seen in clinical practice. Types of intervention(s) The intervention of interest for this review is the topical application of an anaesthetic prior to conducting the FEES procedure. Studies comparing swallow function/competency during a FEES procedure, with and without anaesthetic, will be considered for inclusion in the review. With respect to the kind of anaesthetic used, only studies that examined the effects of nasal introduction of anaesthetic (spray or direct application to the nasal mucosa), regardless of dosage, anaesthetic, type of anaesthetic, timing of introduction of the anaesthetic and who applies the anaesthetic, will be included, as this best reflects clinical practice. Comparators are anticipated to include placebo, lubricant or vasoconstrictor only. Types of outcomes The main outcomes of interest for this review are measures of physiological aspects of swallow function and measures of client pain and/or discomfort. Measures of physiological aspects of swallow function Studies where objective measures (such as videofluoroscopy) of swallow function/competency have been utilised will be preferentially sought. The review will however consider studies that have utilised subjective measures, such as validated swallow rating scales.  These features of swallowing are regularly evaluated to determine dysphagia. Speech pathologists routinely evaluate normal and abnormal function in these parameters. Measurement will be the clinicians’ evaluations of evidence of dysphagia. Measurement might also include simultaneous videofluoroscopic evaluation, and inter-rater reliability evaluation. Client pain and/or discomfort Studies that report any measures of client discomfort and/or pain related to undergoing a FEES procedure either with or without an anaesthetic will be considered for inclusion in this review. Anticipated outcome measures include but are not limited to: self-reported pain/discomfort (such as via visual analogue scales), behavioural observation by clinician, pain/discomfort, patient anxiety measured by index scales, visual analogue score sheets, questionnaires.