Objectivity, Subjectivity, and Validity in Fiberoptic Endoscopic Evaluation of Swallowing
Objectivity, Subjectivity, and Validity in Fiberoptic Endoscopic Evaluation of Swallowing
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Both fluoroscopy and fiberoptic endoscopic evaluation of swallowing (FEES; also known as flexible endoscopic evaluation of swallowing) are considered “gold standard” dysphagia assessment procedures. Both have their strengths and weaknesses, and clinicians using either procedure can use various objective, subjective, and/or valid assessments to determine the nature and severity of a patient’s dysphagia. This session reviews what it means for a measure to be objective, subjective, and/or valid and applies these concepts to FEES. The presenters also discuss other, equally important, criteria to consider when evaluating a patient for dysphagia: accuracy, meaningfulness, and relevancy.

This course is a recorded session from the 2022 online conference “Controversies and Consensus in Dysphagia Management.”

Learning Outcomes
After completing this session, you will be able to:

  • Interpret psychometric properties of visuo-perceptual and semi-automatic measures to judge their reliability, validity, and responsiveness
  • Relate psychometrics to patient-directed outcomes of accuracy, meaningfulness, and relevancy
  • Discuss requirements and processes of instrument development in FEES


  • History
  • Current status of FEES
  • Subjectivity
  • Objectivity
  • Psychometrics of FEES

Presenter Information

Susan E. Langmore, PhD, CCC-SLP, BCS-S, is Professor, Otolaryngology, Boston University School of Medicine. She recently moved back to San Francisco, where she limits her work to research, lecturing, teaching FEES courses, and contributing to several professional boards. She draws on many years of clinical practice and teaching as well her research accomplishments. Dr. Langmore is best known for developing the FEES procedure and for her work in aspiration pneumonia. Recently, she completed a clinical trial for treatment of dysphagia in head/neck cancer patients. She has been awarded both Fellow of ASHA and Honors of the Association.

Financial Disclosures:

  • Financial compensation from ASHA for this presentation
  • NIH grant
  • Part ownership interest in LLC

Nonfinancial Disclosures:

  • None

Gintas Krisciunas, MPH, MA, is a Research Assistant Professor of Otolaryngology at Boston University School of Medicine and Boston Medical Center. Gintas’ research focuses on clinical outcomes, with a particular focus on head and neck cancer treatment morbidity. His interdisciplinary research involves testing behavioral treatments for radiation-induced dysphagia, designing outcome measurement instruments, and creating/testing novel medical technologies related to surgical margin guidance and endoscopy. He has served as a PI, Co-I, or project manager on a number of NIH, PCORI, industry, and internally funded clinical research projects and serves as a member of the Boston University Medical Center IRB.

Financial Disclosures:

  • Financial compensation from ASHA for this presentation
  • Salary for employment from Boston University
  • Ownership interest in Langmore FEES, LLC

Nonfinancial Disclosures:

  • None

Renée Speyer, PhD, was appointed as Professor at the University of Oslo (UiO, Norway) in 2017 in recognition of her expertise in the illness trajectory of dysphagia. After graduating as a Dutch speech pathologist, she earned master's degrees in speech and language pathology, health professions education, and epidemiology. Currently, she is undertaking research projects both nationally and internationally involving clinimetrics, instrument development, and developing evidence-based interventions in allied health. As an epidemiologist, she has a strong interest in evaluating the validity and reliability of assessments and testing the efficacy of interventions. Speyer is a frequently invited speaker at international conferences and has published over 100 scientific internationally peer-reviewed articles. Since 2009, she has been an elected board member of the European Society for Swallowing Disorders (ESSD).

Financial Disclosures:

  • Financial compensation from ASHA for this presentation

Nonfinancial Disclosures:

  • None

Assessment Type

Self-assessment—Think about what you learned and report on the Completion Form how you will use your new knowledge.

To earn continuing education credit, you must complete the learning assessment by April 30, 2027.

Program History and CE Information

Content origination date: March 2022
End date: April 30, 2027

This course is offered for 0.1 ASHA CEUs (Intermediate level, Professional area).

Related Courses

View all courses from the Controversies and Consensus in Dysphagia Management online conference.

Continuing Education

4/30/2022 to 4/30/2027

Product Information

Item #(s): PD102474
Client Age: Adults
Format(s): eWorkshop
Language: English
Author: Gintas Krisciunas, MPH, MA; Susan L Langmore, PhD, CCC-SLP, BCS-S; Renee Speyer, PhD

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