Simultaneous modified Evans blue dye procedure and video nasal endoscopic evaluation of the swallow

Objective. To investigate the results of the modified Evans blue dye test (MEBD) aspiration detection rate to the video nasal endoscopic examination of the swallow (VEES) during simultaneous studies with direct viewing of the subglottis through the tracheostomy site opening by means of endoscopy. Study Design: Prospective, consecutive. Methods: Fifteen consecutive simultaneous MEBD and VEES studies were completed on patients with tracheostomies at an acute care rehabilitation hospital over a 4-month period. All patients were referred to the swallowing center for a video nasal endoscopic examination who had known or suspected dysphagia. Results: Aspiration was present in 53% (8) of the studies as documented by the VEES. The MEBD showed an overall 50% false-negative error rate for the detection of aspiration as compared with the VEES. The MEBD identified aspiration in 67% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%). Conclusion: The results of the current investigation suggest that the MEBD, at best, should be viewed only as a screening tool for the presence of gross amounts of aspiration in patients with a tracheostomy.