{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T01:52:29Z","timestamp":1791424349284,"version":"4.3.3"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1R01CA271223\u201001A1"],"award-info":[{"award-number":["1R01CA271223\u201001A1"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Limited normative reference data are available for validated outcomes of flexible endoscopic evaluation of swallowing (FEES). We aimed to examine healthy swallowing via FEES in community\u2010dwelling healthy adults to derive a preliminary reference dataset of normative validated FEES outcomes to guide clinical interpretation and diagnostic decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with no history of dysphagia\u2010related disease underwent simultaneous videofluoroscopy and FEES imaging using a standardized 11\u2010item bolus protocol. Trained raters performed duplicate, independent, blinded ratings of the New Zealand Secretion Scale (NZSS), Penetration\u2010Aspiration Scale (PAS), and Dynamic Imaging Grade of Swallowing Toxicity\u2010FEES (DIGEST\u2010FEES) validated scales. Descriptive statistics were performed at the bolus (PAS) and participant level (NZSS, DIGEST\u2010FEES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      361 swallows from 33 community\u2010dwelling adults (36.6\u2009\u00b1\u200914.7\u2009years old) were analyzed. In rank order, distribution profiles were: (1)\n                      <jats:italic>NZSS<\/jats:italic>\n                      : 95% normal (NZSS\u2009=\u20090), 5% abnormal (NZSS\u2009=\u20094); (2)\n                      <jats:italic>Worst PAS<\/jats:italic>\n                      : 73% safe (PAS 1\u20132,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924), 21% penetration above the true vocal folds (PAS 3,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097), 6% deep penetration to the true vocal folds (PAS\u2009=\u20095,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092); (3)\n                      <jats:italic>DIGEST\u2010FEES Safety Grades<\/jats:italic>\n                      : 91% Grade 0 (normal,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930), 9% Grade 1 (mild impairment,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093); (4)\n                      <jats:italic>DIGEST\u2010FEES Efficiency Grades<\/jats:italic>\n                      : 73% Grade 0 (normal,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924), 24% Grade 1 (mild impairment,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098), 3% Grade 2 (moderate impairment,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This preliminary healthy FEES dataset highlights variation in swallowing safety and efficiency and suggests careful interpretation of FEES outcomes to avoid over\u2010pathologizing impairment. Future studies are warranted to obtain additional normative data in diverse populations to further understand normal variation in FEES outcomes to guide clinically meaningful diagnostic cut\u2010points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      3\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 135:1034\u20131038, 2025\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.31814","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T23:54:39Z","timestamp":1728604479000},"page":"1034-1038","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Preliminary Normative Reference Values of Validated\n                    <scp>FEES<\/scp>\n                    Scales in Healthy Young Adults"],"prefix":"10.1002","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-6081","authenticated-orcid":false,"given":"Cara","family":"Donohue","sequence":"first","affiliation":[{"name":"Aerodigestive Research Core Laboratory The Ohio State University  Columbus Ohio U.S.A."},{"name":"Department of Hearing and Speech Sciences Vanderbilt University  Nashville Tennessee U.S.A."},{"name":"Innovative Research in Aerodigestive Disorders Laboratory Vanderbilt University Medical Center  Nashville Tennessee U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla","family":"Croft","sequence":"additional","affiliation":[{"name":"Aerodigestive Research Core Laboratory The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Maristela","sequence":"additional","affiliation":[{"name":"Aerodigestive Research Core Laboratory The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Folsom","sequence":"additional","affiliation":[{"name":"Aerodigestive Research Core Laboratory The Ohio State University  Columbus Ohio U.S.A."},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3710-5706","authenticated-orcid":false,"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas U.S.A."},{"name":"Division of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K.","family":"Plowman","sequence":"additional","affiliation":[{"name":"Aerodigestive Research Core Laboratory The Ohio State University  Columbus Ohio U.S.A."},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery The Ohio State University  Columbus Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/17549507.2018.1461931"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-021-10317-0"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1044\/2019_JSLHR-S-18-0448"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1044\/2023_JSLHR-23-00246"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-018-9924-5"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-012-9437-6"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1044\/2023_JSLHR-23-00132"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00417897"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21116"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940911800306"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489417742161"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-021-10293-5"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1044\/2021_AJSLP-21-00116"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/17549507.2018.1458901"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34079"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1044\/2021_JSLHR-21-00014"},{"key":"e_1_2_6_18_1","article-title":"Diagnosis 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Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.31814","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T01:07:14Z","timestamp":1739754434000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.31814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,10]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1002\/lary.31814"],"URL":"https:\/\/doi.org\/10.1002\/lary.31814","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,10]]},"assertion":[{"value":"2024-07-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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