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FEES stands for Fiber optic Endoscopic Evaluation of Swallowing.

The Fiber optic Endoscopic Evaluation of Swallowing (FEES) is a procedure used by speech-language pathologists to evaluate the pharyngeal stages of swallowing. The portable study uses a flexible fiber optic laryngoscope which is passed transnasally to the hypopharynx. The scope hangs above the epiglottis and does not pass between the vocal folds. Patients are seated in a functional feeding position and are offered a variety of food consistencies while the swallow is viewed on a TV monitor. The study is recorded and video prints can be left in the medical chart.

The clinician can clearly view laryngeal and pharyngeal structures. The patient is led through various tasks to evaluate the sensory and motor status. Food and liquid are given to the patient so that swallow ability can be determined.

The primary objectives of the FEES are similar to MBS: to assess the pharyngeal stage of swallowing; to detect aspiration; and to determine the safest and least restrictive diet level for the patient.

The major advantages of the FEES compared to MBS are:

  • Cost effective
  • Portability to bedside
  • No radiation
  • No Barium which is distasteful to the patient
  • Uses actual meal tray items
  • Direct viewing of laryngeal functioning for airway protection
  • Functional - it simulates natural every day eating
  • Quick testing and results
  • Used to train the patient via biofeedback
  • Assesses secretions management before risking aspiration of a feeding trial
  • Better assessment of neurological status (including sensation)
  • More detailed rendering of the anatomy than other methodologies
  • Reliable in detecting aspiration
  • Strong evaluation tool in the establishment of treatment and compensatory strategies


 

Information obtained from the FEES examination includes:

  • Ability to protect and sustain protection of the airway
  • Ability to initiate a prompt swallow
  • Timing and direction of movement of the bolus
  • Ability to clear the bolus during the swallow
  • Presence of pooling and residue of material
  • Sensitivity of the pharyngeal/laryngeal structures
  • The effect of anatomy on the swallow


 

Appropriate postural changes and swallowing maneuvers are attempted to detect problems and enable the examiner to make recommendations regarding optimal interventions to improve the safety and efficiency of the swallow, the advisability of oral feeding, and use of appropriate behavioral strategies that facilitate safe and efficient swallowing. The most critical finding is aspiration, and the literature demonstrates that FEES is able to detect this finding with good sensitivity.