Research and Literature

1. Evidence of aspiration/penetration after the swallow, and how fatigue can impact swallow function can be appreciated to a greater level on FEES because the recording lasts longer than the MBSS.

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2. The direct visualization, in color, of anatomy during FEES allows for assessment of tissue/muscle function and anatomical variants, providing insight into the true etiology for the dysphagia.

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3. FEES has proven to be a good assessment of vocal cord function and saliva management, high risk factors associated with aspiration pneumonia.

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4. FEES allows the clinician to observe the transition from breathing to apnea during swallowing

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5. Aspiration occurs about 25% of the time BEFORE the swallow, about 10% DURING the swallow, and about 65% AFTER the swallow.

• Takahashi, N, Kikutani, T, Tamura, F., Groher, M., & Kuboki, T. (2012). Videoendoscopic assessment of swallowing function to predict the future incidence of pneumonia of the elderly. Journal of Oral Rehabilitation, 39; 429-437.

• Butler, S.G., Maslan, J., Stuart, A., Leng, X., Wilhelm, E., Lintzenich, C.R., Williamson, J., & Kritchevsky, S.B. (2011). Factors influencing bolus dwell times in healthy older adults assessed endoscopically.  Laryngoscope, Dec; 121(12): 2526-34.

• Allen, J.E., White, C.J., Leonard, R.J., & Belafsky, P.C (2010). Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagia.  Journal of Otolaryngology Head and Neck Surgery, 142(2): 208-13.

• Warnecke, T., Ritter, M.A., Kroger, B., Oelenberg, S., Teismann, I., Heuschmann, P.U., Ringelstein, E.B., Nabavi, D.G., & Dziewas, R. (2009). Fiberoptic endoscopic dysphagia severity scale predicts outcome after acute stroke. Cerebrovascular Disease, 28(3):283-9

• Aviv, J.E. (2000). Prospective, randomized outcome study of endoscopy vs. modified barium swallow in patients with dysphagia. Laryngoscope,  100, 563-574.

• Leder, S.B. & Sasaki, C.T. (2001). Use of FEES to assess and manage patients with head and neck cancer. In Langmore, S.E., editor. Endoscopic evaluation and treatment of swallowing disorders. New York: Thieme; 201-212.

• Smith, C.H., Logemann, J.A., Colangelo, L.A., Rademaker, A.W., & Pauloski, B.R. (1999). Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia, 14: 1-7.

• McCulloch T.M., Langmore S.E., Palmer P.M, & Jaffe D. (1998). Timing of glossopharyngeal events during swallow: a combined electromyographic and endoscopic evaluation. Dysphagia,13:123.

• McCulloch T.M., Langmore S.E., & Palmer P.M. (1997). Timing of glottis closure during swallow: a combined electromyographic and endoscopic evaluation. Dysphagia, 12:111.

• Murray, J., Langmore, S.E., Ginsberg, S., & Dostie, A. (1996). The significance of accumulated oropharyngeal secretions and swallowing frequency in predicting aspiration.  Dysphagia, 11:99-103.

1. Of the potential risks associated with endoscopy, including gagging, epistaxis, laryngospasm, and vasovagal response; a mild case of epistaxis is the most prevalent.

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2. The rate of complications associated with FEES is less than 1% overall.

3. FEES has proven to be a safe and well tolerated method of assessing swallow function when performed by a trained Speech Language Pathologist.

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4. Studies show that endoscope placement does not adversely affect swallow function.

• Nacci, A., Matteucci, J., Romeo, S.O., Santopadre, S., Cavaliere, M.D., Barillari, M.R., Berrettini, S., & Fattori, B. (2016). Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations. ENT, Audiology and Phoniatrics Unit, Department of Neurosciences, University of Pisa, Italy. Folia Phoniatr Logop, 68(1):37-45. 

• Warnecke, T., Teismann, I., Oslenber, S., Hamacher, C., Ringelstein, E.B., Schabitz, W.R., & Dziewas, R. (2009). The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke, 40(2):482-6.

• Suiter, D. M., & Moorhead, M. K. (2007). Effects of flexible fiberoptic endoscopy on pharyngeal swallow physiology. Otolaryngology-Head and Neck Surgery, 956-858.

• Aviv, J.E., Murray, T., Zschommler, A., Cohen, M., & Gartner, C. (2005).  Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1340 consecutive examinations.  Annals of Otology, Rhinology & Laryngology,114:173-176.

• Cohen, M.A., Setzen, M., Perlman, P.W., Ditkoff, M., Mattucci, K.F., Guss, J. (2003). The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting.  Laryngoscope, 113:21-24.

• Aviv, J.E., Kaplan, S.T., Thompson, J.E., Spitzer, J., Diamond, B., Close, L.G. (2000). The safety of flexible endoscopic evaluation of swallowing with sensory testing: an analysis of 500 consecutive evaluations. Dysphagia,15:39-44.

• Wu, C.H., Hsiao, T.Y., Chen, J.C., Chang, Y.C., &Lee, S.Y. (1997). Evaluation of swallowing safety with fiberoptic endoscope: Comparison with video fluoroscopic technique.  Laryngoscope, 107, 396-401.