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FEES vs MBSS.png


When you have the choice between them,

why choose FEES?




Over the past 30 years, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) has become a GOLD STANDARD of swallowing evaluation alongside traditional Modified Barium Swallow Studies (MBS or "video x-ray").  Clinical research shows that while FEES and MBS have a 97% inter-rater reliability, FEES is actually higher in specificity for identifying penetration, aspiration, residue, and spillage.


FEES is a more sensitive tool because, compared to the black-and-white video x-ray of MBS, FEES provides a high-definition color video of the soft tissue structures of the pharynx and larynx.  This makes it easy to see the exact pathway of foods and liquids, including the location and amount of residue and secretions, the role of edema and abnormal structures in dysphagia, and airway protection including vocal fold closure. 


       While each test has unique strengths and advantages and may be used in different circumstances, there are numerous other benefits to FEES:          

Convenient. Wyoming Dysphagia Diagnostics can complete the study

1-2 days after order is received.

Completed at the bedside, with patient seated in their "natural" eating position, which is ideal for medically fragile patients, obese patients, and those unable to tolerate transport/positioning for MBS.

Can be completed in the ICU.

Records a high definition, color video of the larynx and pharyngeal swallow. 

Superior to MBS for visualizing abnormal soft tissue structures, edema, secretion management, penetration, aspiration, vocal fold function, airway closure, and location and amount of residue.  Ideal for pharyngeal dysphagia.

NO radiation exposure, meaning it is

safe for children

Can accurately see what happens over the course of a meal, including effects of  impulsivity, fatigue, postural changes, etc.

Uses "real food" vs barium, and can try patient's typical foods and medications.

Does not require a radiologist.  Patient's primary SLP may participate in the study to try compensatory strategies and bill for treatment, which helps with continuity of care and meeting productivity requirements.

Fiberoptic Endoscopic Evaluation of Swallowing


Costs 1/4 the price of MBS!

Portable. We come directly to your facility, cutting down on patient transportation costs

Must be completed in a radiology suite.  Patient must be able to tolerate transportation and be able to sit upright in MBS chair for the procedure. 

Can not be completed in the ICU.

Records black-and-white video x-ray of primarily the lateral view of the three phases of the swallow.

Difficult to tell the exact amount or location of secretions. However, it is ideal if primarily oral or esophageal dysphagia are suspected, or for viewing bony abnormalities. 

Exposes patient to radiation.

Snapshot in time.  Difficult to assess fatigue due to time constraints and need to limit radiation exposure.

Requires barium-coated food and liquids, which has tripled in cost due to barium shortages in recent years, and can be

harmful to the lungs if aspirated.

Requires a radiologist or radiology tech to be present.  If patient comes from an outside facility to the hospital for MBS, their primary SLP may not see or participate in the study, and facility may miss out on treatment minutes.

Modified Barium Swallow Study (MBS)

Costs for MBS in Wyoming can be $1,500-1,800

Typically take up to 8 days after ordered to be completed.  Availability limited by time constraints & scheduling with hospital SLP and radiology department.

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