Objective: The modified barium swallow study (MBS) or the videofluoroscopic swallow study (VFSS) has been the gold standard for dysphagia diagnosis. Fiberoptic endoscopic evaluation of swallowing (FEES) is also gaining popularity in diagnosing dysphagia. This study aimed to compare the efficacy of FEES with that of MBS in patients with dysphagia. Methods: The study included 24 patients who underwent FEES and MBS simultaneously. The Eating Assessment Tool-10 questionnaire was administered to assess swallowing symptoms. The FEES and MBS data, including residue, penetration, and aspiration, were compared. The sensitivity, specificity, positive predictive value, and negative predictive value of each diagnostic test were analyzed. Results: The two tests showed no significant differences for swallowing of semi-solid foods and drinking liquids from a cup. However, significant differences were observed in the swallowing of thin liquid, thick liquid, puree, and solid diets (P＜0.05). FEES demonstrated higher sensitivity than MBS for aspiration (86.67% vs. 60.00%) and penetration (94.12% vs. 88.24%), and also had higher negative predictive values for aspiration (81.82% vs. 60.00%) and penetration (87.50% vs. 77.78%). Six cases exhibited silent aspiration, of which FEES identified five cases and MBS identified three cases. Conclusion The results of this study showed that FEES has a higher sensitivity for penetration and aspiration compared to MBS. FEES also enabled better sensory assessments of the larynx, which is not possible with MBS, thus allowing for the evaluation of the cough reflex. FEES and MBS have their respective strengths and limitations, and they can be used complementarily based on specific clinical situations.

Base of tongue is the most common location of ectopic thyroid. Conservative management is the mainstay of treatment, but surgical treatment is required when complications occur due to the airway obstruction, dysphagia, or hemorrhage. An 18-year-old male with dyspnea and voice change was diagnosed with lingual thyroid, and the symptoms were refractory after several months of thyroid hormone replacement. The lingual thyroid gland was surgically excised using transoral robotic surgery (TORS). Although there are many surgical approaches for the resection of the lingual thyroid, TORS has advantages of using the natural orifice, and leaving no scar on the cervical area. Herein, we report a case of TORS-assisted lingual thyroidectomy with a literature review.