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FEESST
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FEESST

I have had frequent episodes of sinusitis, sinus infections, bronchitis, wheezing and coughing for years.  I was dx with asthma triggered by URI's.  I have never responded to a rescue inhaller.  I went to an allergest about 2 months ago.  He is not convinced that I have asthma.  Allergy testing was done.  I was negative for all common allergies.  The allergist told me to have a cat scan of the sinuses next time I started with sinus symptoms.  The cat scan showed that I had pan sinusitis and that the cannal that connects the sinuses to the nasal passage was occluded. When my primary saw the report, he sent me to an ent who said that I needed sinus surgery.  I was formally dx with reflux about 3 months ago.  I mentioned this to the ent and asked if the reflux can be causing the sinus problems.  He said no.  A few days later I had a scheduled appointment wlith the allergist.  He felt that I had to find out if my reflux was adequately controlled before deciding about sinus surgery.  I got the name of a second opinion ent from the allergist.. The second opinion ent also said that I need sinus surgery.  He felt that reflux that is not adequately controlled can exasberbate the bronchial symptoms but felt that the sinus issues were independent of the reflux.  The ent wants me to come back in two weeks for Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST).  I do not have any problems swallowing.  In fact, I can dry swallow medication.  A few days after seeing the second ent, I went to a gastro.  The gastro felt that I can still have silent reflux and wants to do a video endoscapy with a biopsy to get a better picture what is happening.

Is the Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) necessary if I don't have swallowing problems.  What would the FEESSTT show that the endoscaspy wouldn't?  Would the FEESST give information that can be helpful with the surgery or in planning subsequent treatment?  



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You say, "I was formally dx with reflux about 3 months ago."     If that is the case, why does the GI specialist feel that, "I can still have silent refluex?"  If the initial positive test for reflux is valid?  You might ask the gastro why he needs to confirm it with video endoscopy with biopsy, and, why not just treat it?

I agree that the presumed GERD probably has little or nothing to do with the sinusitis.  You may well need sinus surgery but, before you agree to it, you should sit down with the ENT (1st and/or 2nd) and ask exactly what he/she proposes to do surgically, the rationale for it and the expected outcome based, at least in part, on the degree of satisfaction of patients of his/hers who had this surgery.

If you are still interested in working with the 2nd ENT, you should ask him/her to explain exactly why the FEESST is necessary and what decisions will be based on the findings.  Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) is a comprehensive endoscopic assessment of the sensory and motor components of a swallow. FEESST is a relatively safe procedure for the sensory and motor assessment of dysphagia (difficulty swallowing.)

Also ask what has led the 2nd ENT to suspect that the FEESST will be revealing of disease.  And, since its primary value is for the assessment of dysphagia, and you report that you have had no difficulty swallowing, why do it? The information included in your message, neither supports nor refutes this recommendation.

Good luck
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