A FEES procedure was chosen as the gold standard reference test to which CA ratings would be compared, as per literature [6, 8, 16]. A standardized FEES (based on Langmore’s protocol, 1988 [41]) was conducted by SLPs (n = 2), or Otolaryngologists (n = 4) with an accompanying SLP, with a range of FEES experience of 2–12 years. All FEES assessors had access to all patient background and clinical information which was reviewed prior to FEES.
This study chose to use FEES as the "gold standard" of swallow studies to compare with cervical auscultation. However, in my experience, the Videofluoroscopic Swallow Study (VFSS) is typically seen as the gold standard for swallow studies. Also, I have personally found FEES to be a less common procedure completed compared to VFSS. While I understand why the researchers chose to use FEES to compare to CA (to complete multiple swallows at bedside and without radiation exposure), they do a poor job of explaining their reasoning in the passage. They list FEES and VFSS as the gold standards, but do not explain why they chose FEES over VFSS for the study. Additionally, the wide range of experience in SLPs who completed the FEES procedure in this research study introduces a potential variability that could affect the reliability of the test results. This gap in experience provides room for additional factors, such as less experience and less comfort level with FEES, to affect the outcome of the study. To increase the validity of the study, the experience levels should be narrowed.