Rethinking Residue: Determining the Perceptual Continuum of Residue on FEES to Enable Better Measurement

Jessica M. Pisegna, Asako Kaneoka, Rebecca J Leonard, Susan E. Langmore

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


The goal of this work was to better understand perceptual judgments of pharyngeal residue on flexible endoscopic evaluation of swallowing (FEES) and the influence of a visual analog scale (VAS) versus an ordinal scale on clinician ratings. The intent was to determine if perceptual judgments of residue were more accurately described by equal or unequal intervals. Thirty-three speech language pathologists rated pharyngeal residue from 75 FEES videos representing a wide range of residue severities for thin liquid, applesauce, and cracker boluses. Clinicians rated their impression of the overall residue amount in each video on a VAS and, in a different session, on a five-point ordinal scale. Residue ratings were made in two separate sessions separated by several weeks. Statistical correlations of the two rating methods were carried out and best-fit models were determined for each bolus type. A total of 2475 VAS ratings and 2473 ordinal ratings were collected. Residue ratings from both methods (VAS and ordinal) were strongly correlated for all bolus types. The best fit for the data was a quadratic model representing unequal intervals, which significantly improved the r2 values for each bolus type (cracker r2 = 0.98, applesauce r2 = 0.99, thin liquid r2 = 0.98, all p < 0.0001). Perceptual ratings of pharyngeal residue demonstrated a statisticalrelationship consistent with unequal intervals. The present findings support the use of aVAS to rate residue on FEES, allowing for greater precision as compared to traditionalordinal rating scales. Perceptual judgments of pharyngeal residue reflected unequalintervals, an important concept that should be considered in future rating scales.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
StateAccepted/In press - Aug 30 2017


  • Deglutition
  • FEES
  • Pharyngeal residue
  • Prothetic continuum
  • Ratings
  • Visual analog scale

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Gastroenterology
  • Speech and Hearing


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