What is FEES?

At Dysphagia in Motion, we understand there can be some questions you might have about FEES and we're here to answer them!

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If you couldn't find the answers to your questions or would like more information, please reach out.

During the procedure, a flexible endoscope is introduced transnasally to the patient's hypopharynx where the SLP can clearly view laryngeal and pharyngeal structures. 

The patient is then led through various tasks to evaluate the sensory and motor status of the pharyngeal and laryngeal mechanism.  Food and liquid boluses are then given to the patient so that the integrity of the pharyngeal swallow can be determined. 

Videofluoroscopy (MBSS) has long been viewed as the "gold standard" for evaluation of a swallowing disorder for the comprehensive information it provides.  However, it is not very efficient and accessible in certain clinical and practical situations.  Flexible endoscopic evaluation of swallowing (FEES) has been shown to be safe and effective for assisting in swallowing evaluation, and in therapy as a visual display to help patients learn various swallowing maneuvers. Multiple research articles have also repeatedly proven that FEES is just as accurate and with even better sensitivity and specificity than MBSS.

Please see our Research and Literature page to learn more. 

Flexible endoscopic evaluation of swallowing (FEES) is the preferred test over videofluoroscopy in the evaluation of a swallowing disorder in any of the following conditions:

·         A more conservative examination than videofluoroscopy is required because of concerns about aspiration of barium, food, and/or liquid; or

·         Need to assess fatigue or swallowing status over a meal; or

·         Repeat examination to assess change; to assess effectiveness or need for maneuvers; or

·         Severe dysphagia with very weak or possibly absent swallow reflex and/or very limited ability to tolerate any aspiration (e.g., brainstem stroke, member tube-fed for prolonged period, very poor pulmonary status, or, poor immunologic status); or

·         Therapeutic examination that requires time to try out several maneuvers, several consistencies, etc. (e.g., want to try real foods; want parent to hold baby in several positions; or want to try biofeedback); or

·         To visualize the larynx directly for signs of trauma or neurological damage and assess laryngeal competence post-intubation or post-surgery (especially with coronary artery bypass grafting, carotid endarterectomy, or any surgery where the recurrent laryngeal nerve was vulnerable); or

·         When positioning for fluoroscopy is problematic (e.g., member bedridden, weak, has contractures, in pain, has decubitus ulcers, quadriplegic, wearing neck halo, obese, or, on ventilator); or

·         When there is a suspicion that laryngeal competence may be compromised in a member with a tracheostomy; or

·         When transportation to fluoroscopy is problematic (e.g., medically fragile/unstable member in an intensive care unit, cardiac or other monitoring in place, on ventilator, or, nursing/medical care must be with member); or

·         When transportation to the hospital is problematic (e.g., nursing home issues, including cost of transportation, resources needed to accompany member, strain on member, or, member fearful of leaving familiar surroundings, etc.).

Although FEES can be performed on virtually any person of any age, the following populations benefit greatly from endoscopy:

·         Ventilator dependent patients

·         Patients who easily fatigue

·         Patients unable to leave contact isolation rooms

·         Suspected aspiration of secretions

·         Suspected laryngopharyngeal reflux

·         Patients with known vocal fold paresis or paralysis 

·         Patients with contractures or decubitus ulcers who cannot maintain upright positioning

·         Suspected intubation/extubation trauma, including edema or erythema

·         Patients with chronically wet vocal quality or throat clearing

·         Dementia or TBI patients who are routinely confused and/or unable to follow commands 

Information obtained from this examination includes ability to protect the airway, the ability to sustain airway protection for a period of several seconds, the ability to initiate a prompt swallow without spillage of material into the hypopharynx, timing and direction of movement of the bolus through the hypopharynx, ability to clear the bolus during the swallow, presence of pooling and residue of material in the hypopharynx, timing of bolus flow and airway protection, sensitivity of the pharyngeal/laryngeal structures, and the effect of anatomy on the swallow.

Since only approximately 5% of aspiration occurs DURING the swallow, we're able to see the other 95% beautifully during the FEES procedure. If the patient falls in that 5%, we are able to see the aspirated food trials below the level of the vocal folds after the brief "white-out" phase that lasts only 1/10th of a second.

Perfect, so do we! Before we start the procedure, a thorough Oral Mech Exam tells us what we need to know about oral strength, coordination, and range of motion. During the study, the FEES procedure can reveal mastication efficacy/efficiency by allowing us to view the actual masticated bolus in high-definition video as it passes the epiglottis. Remember that viewing the oral phase does not change whether the patient is aspirating or not, and it does not reveal the amount of spillage or residue that can lead to aspiration after the swallow. If you're concerned about residue after the swallow, simply ask the patient to open their mouth.

Although both FEES and MBSS procedures can detect signs and symptoms of esophageal dysphagia, unfortunately SLPs are unable to diagnose these conditions. If we truly suspect esophageal dysfunction, a referral should be made to a GI doctor for further evaluation.

The American Speech and Hearing Association (ASHA) has approved endoscopy to be utilized by highly specialized and licensed Speech Language Pathologists to assess swallowing function. Furthermore, the state of Louisiana (similar to 46 other states) does not require a physician to be present or to interpret results of the study. Please see ASHA's Use of Endoscopy by Speech-Language Pathologists: Position Statement for further details. 

The procedure typically takes between 10-15 minutes (excluding set-up time and education), however, the scope can be left in the hypopharynx for as long as needed to assess factors such as fatigue, compensatory strategies, identify signs of laryngopharyngeal reflux, etc.

The average cost for FEES ranges based on geographical location and patient needs, however, we can guarantee that FEES is a faster, more cost-effective solution for your facility based on reimbursement rates. We also offer a steep discount for private pay patients who don't have insurance. Please contact us if this applies to you.