J Korean Dysphagia Soc.  2022 Jan;12(1):59-63. 10.34160/jkds.2022.12.1.007.

Standardization of FEES Evaluation for the Accurate Diagnosis of Dysphagia

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
  • 2Department of Otorhinolaryngology-Head & Neck Surgery, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan, Korea
  • 3Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
  • 4Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
  • 5Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
  • 6Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
  • 7Department of Otorhinolaryngology, College of Medicine, Seoul National University, Seoul, Korea


Fiberoptic endoscopic evaluation of swallowing (FEES) is a standard diagnostic tool for swallowing disorders. However, it has not been used frequently in Korea because of the long test time, low cost, and the absence of a standard evaluation system. The purpose of this study was to suggest a standard fill-out form for the FEES result.
From February 2019 to June 2020, a total of 98 FEES tests were performed by an otolaryngologist (JYJ) at the Wonkwang University Hospital. After the exclusion of 68 cases, 30 cases were analyzed twice by 4 raters with over 5 years of experience as otolaryngologists working in various hospitals. The results were measured for the rater’s test-retest reliability and inter-rater consistency.
Cohen’s kappa values for measuring the intra-rater consistency of the four raters were 0.984, 0.887, 0.848, and 0.930, respectively, meaning very good alignment of 0.8 or more, respectively. The Fleiss Kappa value for measuring inter-rater consistency was 0.276, meaning ‘fair’ for values of 0.2 or more. To examine consistency, an intraclass correlation coefficient (ICC) analysis conducted by assuming the grading score to be a constant continuous variable gave an ICC value of 0.729 (P<0.001), showing a very reliable tendency.
In this study, all the items of the fill-out form were rated using a three-step grading scale, so the degree of agreement was high when performed twice by the same rater, but the degree of agreement among raters was relatively low. Therefore, our fill-out form for FEES will be useful in evaluating the improvement of a patient over the course of clinical treatment.


Fiberoptic endoscopic evaluation of swallowing; Swallowing disorder; Fill out form
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