Flexible Endoscopic Evaluation of Swallowing (FEES)
About the Exam
FEES is a safe, well tolerated diagnostic swallowing assessment. A specialized scope is passed through the nasal cavity and into the oropharynx, allowing us to visualize the structures of the laryngopharynx while at rest and while eating or drinking. This approach enables direct observation of the pharyngeal swallowing process, including effects of swallowing strategies, secretion management, and anatomical/physiological variances. The exam can be done with minimal modifications to foods and drinks, enabling assessment of the things patients may find troublesome or preferable to swallow. Total exam time will vary per individual but average duration is 10-20 minutes.
FEES Candidates
Patients who present with symptoms of dysphagia while eating or drinking may benefit from a FEES exam. Symptoms may include cough, throat clearing, choking, change in voice quality/”wet” sounding voice, difficulty breathing during meals, pain when swallowing, or feeling of food getting stuck when swallowing.
FEES is beneficial for patients with dysphagia caused by a variety of anatomical and physiological etiologies. Common candidate conditions may include but are not limited to:
Stroke
Laryngeal Injury
Traumatic Brain Injury
Developmental Delay
Gastric Esophageal Reflux Disease
Respiratory Conditions
Head/Neck Cancer
Head/Neck Surgeries
COPD
Globus Sensation
Recurrent Pneumonias
NPO Patients perhaps ready for oral intake
Patients unable to access instrumental assessment during hospitalization
FEES vs. MBSS
A modified barium swallow study (MBSS), which goes by multiple other names, observes the phases of oropharyngeal swallow and portions of esophageal swallowing in a lateral view. An MBSS is performed by a speech pathologist in a hospital radiology suite; it must be performed in the presence of a radiologist and with assistance from a radiology technician. The test has significant time constraints in place to reduce radiation exposure to the patient. An MBSS requires use of barium food and liquid products in order to visualize the bolus on x-ray.
A FEES exam can be administered by a trained speech pathologist alone and can accommodate the patient in a variety of settings and seating positions. There is no time restraint for the exam duration, which allows a complete assessment of a patient’s swallowing function. Any variety of foods and drinks can be used during the exam, needing only the addition of food coloring for improved visualization.
Pictured: FEES exam view - Left/Above. MBSS exam view - Right/Below.
Why FEES?
Clinicians and researchers agree that instrumental assessment is critical in effective dysphagia management. FEES is a widely utilized, well tolerated procedure that provides a detailed exam of the pharyngeal swallowing mechanism. It is useful in identifying laryngeal and pharyngeal soft tissue abnormalities and their impacts on the safety/efficiency of swallowing. FEES allows for detection of penetration and aspiration events before and after the swallow occurs.
There are no time constraints when performing an assessment, which enables thorough observation of the laryngopharynx between oral trials. Lack of time constraints also permits utilizing a variety of swallowing strategies multiple times to ensure their safety and effectiveness.
FEES is performed by a trained speech-language pathologist and can be offered in a timely manner for a fraction of the price of other instrumental exams. This is due to no additional staffing needs, no radiology equipment/supplies, no transportation expenses, and reduced scheduling demands.
Helping you stay informed.
Our team values educating patients, families, clinicians, and physicians about dysphagia. Call or send us a message for a free consultation, and we will help you decide if a FEES assessment is right for your patient.