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"SEE" the FEES advantage!: Choosing FEES versus MBSS
The Fiberoptic 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 secretions and the laryngeal and pharyngeal structures in color, in contrast to the MBSS (modified barium swallow study) which provides a black & white x-ray view. 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 MBSS: 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 MBSS are:
Information obtained from the FEES examination includes:
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 excellent sensitivity.