About FEES

What are the benefits of using Aspen Speech Therapy to perform FEES?

  • Portable– No transportation cost! The exam can be completed at the patient’s bedside- they can be tested in a bed or chair.
  • Accurate– Multiple studies show that FEES is as accurate as a Modified Barium Swallow Study for detecting aspiration and determining oral diet safety.
  • Cost Saving– The portable FEES exam is less expensive than the Modified Barium Swallow (MBS) study.
  • Safe and well tolerated– The FEES exam is safe and does not expose the patient to any radiation or anesthetic.
  • Supportive Documentation– Professional, comprehensive reports provide detailed information regarding physiology, anatomy, and swallow function. Still photos and/ or video will be available for the facility speech pathologist and/ or physician.
  • Wide array of test materials– no barium flavor! We are able to test a variety of foods and liquids including patient-specific items such as pills and carbonated beverages without alteration of texture or taste.
  • Visual Feedback– Video during the exam may be helpful for patients as biofeedback for improving vocal fold closure and pharyngeal squeeze.

What is FEES?

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a well-established technique that has revolutionized the field of dysphagia diagnostics. FEES is a sensitive, accurate, portable, and safe examination that yields clinically useful information relative to swallowing physiology and swallowing safety. The procedure involves passing a flexible endoscope across the floor of a patient’s nasal passage into the pharynx so that the larynx, pharynx and upper esophageal opening are viewed directly from above. Then the patient is administered food or liquids mixed with food coloring in order to determine safe swallowing function and integrity. FEES can be done at the patient’s bedside, in an office, intensive care unit or in a long-term care facility in under 20 minutes with regular food and liquids. Since there is absolutely no radiation administered the studies are able to be sustained for longer time intervals, allowing the clinicians the ability to tell if a patient’s swallowing technique is impacted by fatigue.

How long has FEES been utilized to diagnosis dysphagia?

Susan Langmore, Ph.D., and coworkers coined the term FEES in 1986 and published the first data demonstrating the effectiveness of the procedure in 1988. It is also known by a few other names such as “video endoscopic evaluation of dysphagia” and “bedside endoscopic swallowing test”.

How does FEES compare to the Modified Barium Swallow Study (MBSS)?

FEES has repeatedly demonstrated a sensitivity equal to or greater than MBSS in determining whether a patient is exhibiting penetration, aspiration, delay in swallowing initiation and pharyngeal residue. Additionally, FEES provides visualizations of pharyngeal secretions that cannot be detected during MBSS.

– No need to coordinate time with radiology department schedule

– No radiation exposure with FEES

– No unpleasant barium-tainted food & no barium-associated constipation for patients

– No waiting to be cleared from isolation precautions

– FEES can be used with patients on mechanical ventilation

– Normal food is given to patients

– FEES can be performed while a patient is sitting upright or in bed

– FEES can be performed easily on morbidly obese patients as opposed to MBSS

– FEES can be given to medically complex patients who otherwise would not tolerate a trip to radiology

– Physician does not have to be present during a FEES study

– The use of the term “gold standard” as applied to MBSS is no longer appropriate

– There may be cost advantages associated with FEES versus MBSS for the inpatient management of dysphagia

Information obtained from the FEES examination includes:

  • Ability to protect and sustain protection of the airway
  • Ability to initiate a prompt swallow
  • Timing and direction of movement of the bolus
  • Ability to clear the bolus during the swallow
  • Presence of pooling and residue of material
  • Sensitivity of the pharyngeal/laryngeal structures
  • The effect of anatomy on the swallow