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Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

How does it Work?


Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a safe, well-tolerated procedure used to assess swallowing function. 


It involves passing a thin, flexible scope along the floor of the nose and resting it in the back of the throat (above the vocal folds) to view soft structures of the pharynx, larynx, and upper esophageal opening.  The clinician then records a high definition, color video as the patient completes a series of tasks, swallows food and liquids, and tries different therapeutic strategies to see in real-time if they are effective in improving symptoms. The scoping process generally only takes 15-30 minutes to complete and provides invaluable information to the SLP to drive a successful treatment plan.

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The FEES Advantage


Research shows a 70% error rate in diagnosing dysphagia at the bedside, where the recommendations are either too restrictive, jeopardizing nutrition and hydration, or silent aspiration is completely missed, which can lead to pneumonia. The ability to SEE what is going on is absolutely critical to aide SLPs in their clinical decision making, and can reduce patient incidences of aspiration pneumonia, re-hospitalizations, and dependence on feeding tubes and thickened liquids.  

Because it allows direct visualization of the soft tissue structures of the throat, FEES is the ideal test if there are concerns for edema (e.g. after intubation), abnormal anatomy, or for patients who are medically fragile and at a high risk of aspirating during a bedside evaluation. FEES can answer the questions: Is my patient aspirating? What diet is appropriate?  What anatomic and physiologic changes are causing their dysphagia? What strategies should we target in therapy?

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What are other benefits of FEES?

  1.  Cost effective compared to MBS          

  2.  Portable! We come directly to the patient's bedside

  3.  Can be completed on medically complex patients who can't tolerate   transportation to radiology

  4.  Can be used in the ICU and on ventilator-dependent patients 

  5.  No radiation exposure or barium used

  6.  Uses patient's typical foods

  7.  Direct view of the larynx and airway protection

  8.  Functional - simulates natural eating in a patient's typical environment 

  9.  Quick testing and immediate results

  10.  Used to train the patient via biofeedback​

What can FEES see?

Vocal Folds
Polyps, Masses, Nodules, Lesions
Premature Spillage Aspiration
Airway protection
Pathway of the food/liquid
Type & amount of residue/secretions

Abnormalities (e.g. thrush)

Swallow Sensitivity

Candidates for FEES?


FEES can be completed on anyone suspected to have difficulty swallowing, or "dysphagia". It is the more practical, ideal choice compared to MBS (Modified Barium Swallow Studies) for patients who are:

  • medically complex and difficult to transport

  • bedbound (e.g. quadriplegic) 

  • in the ICU

  • on mechanical ventilation

  • on isolation precautions (C-Diff, MRSA etc)

  • obese or kyphotic

  • on supplemental oxygen

As well as those who have tracheostomy tubes and feeding tubes (PEG, Duo, NG), and recent intubation. 

                                              Read about FEES vs MBS>>

FEES is NOT indicated for those with:

  • bilateral nasal obstruction,

  • unhealed facial, maxillary, or nasal fractures

  • severe epistaxis (nose bleeds). 

  • high-flow nasal oxygen

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