About FEES
What is FEES?
Fiberoptic endoscopic evaluation of swallowing, or FEES, is an evaluation of an individual's ability to swallow. FEES allows the trained speech-language pathologist to see a patient's swallow function and anatomy before, during, and after swallowing liquids and/or solids. This objective test is performed using an endoscope - a small tube with a camera and light on the end. The tube is flexible allowing for a more comfortable experience. The endoscope is connected to a computer and video monitor and is recorded, allowing for a thorough evaluation of all phases of a patient's swallowing function.
Objective Swallow Assessments Save Lives
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​High definition images and video means increased sensitivity of the evaluation tools
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FEES is conduction in the patient's natural setting in the position patients consume food and liquids
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Patients experiencing silent aspiration do not demonstrate outward signs of swallowing wrong and are an increased risk for aspiration pneumonia
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(McCullough et al., 2005) found a 70% error rate in bedside swallowing evaluations leading inaccurate diet recommendations
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Unlimited timeframe is helpful for patients who may fatigue and demonstrate signs and symptoms of aspiration further along in a meal
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Patients and family are able to view aspiration firsthand which has been shown to increase compliance with recommendations
A Comparison of Swallow Evaluations
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Both FEES and MBSS tests help explain the nature of the dysphagia through views of the anatomy
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The decision of which test to choose is based on your specific patient’s needs and your clinical questions
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A bedside swallow study cannot tell us anything about swallowing physiology - 40% of aspirators are missed
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Several studies showed that FEES is equal to or even better than videofluoroscopy in detecting aspiration and severity of residues (Langmore et al, 1991, Leder et al, 1998, Kelly et al, 2007)
FEES
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FEES answers the question: “Can the patient swallow safely” in a timely fashion, especially when discharge or changing PO status is imminent
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FEES is performed bedside in the position a patient eats (poor positioning and all) and with real food
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View of oral, pharyngeal, and laryngeal anatomy
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Asses vocal fold function - the natural airway protection
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Ability to monitor the time period before and after the swallow closely
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FEES can be performed on patients with poor respiratory status for patients who cannot tolerate aspirating even a trace of barium
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FEES can also evaluate secretion management, ability to phonate and cough, and protect the airway. You can carefully assess only ice chips
MBSS/VFSS
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Modified Barium Swallow Study or Videofluoroscopic Swallow Study
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MBSS/VFSS better visualizes the oral and esophageal phases of the swallow
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This is an x-ray evaluation that allows the Speech-Language Pathologist to evaluate a patient's swallowing function
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Different consistencies of food and liquid are mixed with barium for visibility on the x-ray
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Patients are required to be in an upright seated position
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During a VFSS the x-ray is turned off and on during the evaluation to minimize radiation exposure, limiting the ability to see immediately before and after a swallow
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Fatigue, anxiety, and agitation with transport can impact swallowing performance
Candidates for FEES
FEES can be performed on patients with the following issues:
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Dementia and other neurodegenerative diseases
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CVA
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Bariatrics
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Bedbound
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Cerebral palsy
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Painful wounds
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Feeding tubes
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Isolation precautions
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Supplemental oxygen
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Ventilator dependent
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Tracheostomy tubes or speaking valves
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Medically complex patients
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Cognitively impaired
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Patients unable to be safely transported
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COPD and anyone with reduced respiratory capacity/fatigue
Contraindication for FEES include bilateral nasal obstruction and severe epistaxis.
