What is FEES and Why would I need one?

Jul 12 / Melissa Lorenzo, MS. CCC-SLP, ECDCS, CCFP

Let's start at the beginning.

What is FEES?

FEES is an instrumental swallowing assessment that lets us see inside your throat while you're eating and drinking. The technical name for the assessment is Fiberoptic Endoscopic Evaluation of Swallowing.

FEES is a gold standard in diagnostic swallowing assessments. This means a significant amount of research shows that this assessment is highly reliable and effective in assessing swallow function and aspiration risk.

This test uses an endoscope with a very thin, flexible scope, a tiny camera, and a light on the end. I start by passing the scope, which is only 3.2 mm, along the floor of your nose, past your soft palate, until the camera sits just below the uvula—the hanging part in the back of your mouth. I will then look at different parts of your throat while you swallow different foods and drinks.

Why would you need FEES evaluation?

A FEES may be recommended for several reasons; however, the most common is when someone has swallowing difficulties. If you have difficulty swallowing, you may be at risk for food, medications, liquids, or saliva entering your lungs. If this happens, it can lead to an infection in your lungs known as aspiration pneumonia. You may also be at risk of not eating and drinking enough to maintain your overall nutrition. This could lead to dehydration or malnutrition as well as lower general well-being.

An instrumental assessment, such as a FEES, helps your care team know what is happening inside your throat and if you are at an increased risk of aspirating, acquiring an infection, choking, or if the structures above your esophagus are working just as they should. I believe in seeing and understanding the problem to treat it effectively. The information gathered from a FEES assessment is used to develop a personalized treatment plan to improve your swallowing function, reduce your risk of aspiration, and enhance your overall health and well-being. This personalized approach ensures that your unique needs and circumstances are considered.

FEES is one of two gold-standard tests for instrumental swallowing evaluations – FEES and Modified Barium Swallow Study (MBSS). These types of tests are highly beneficial to you and your care team. They allow us to see how you swallow by looking inside your body instead of relying on only your symptoms and what we can see from the outside. These tests allow SLPs to see the structures inside your throat and how they work together when you swallow. I can then use this information to discuss your swallowing function, make informed recommendations, and work with you to help you improve your strength and safety.

While each of these gold-standard assessments are highly beneficial, they approach the assessment differently and show information differently. With a FEES using the Patcom Distal Chip Endoscope, you will see a full-color picture with a clear and continuous visualization of the inside of your throat, including the back of your tongue, the epiglottis (fancy name for the flap of cartilage in your throat that flips down before you swallow), your vocal cords, and all the little nooks and crannies around them. With a FEES, the recording doesn't stop as it does with a Modified Barium Swallow Study (MBSS). Due to the use of radiation to see the barium-coated foods someone eats, MBSS assessments can miss several vital factors. These may include events before or following the swallow, or they may end up missing the swallow altogether if someone needs too much extra time, as radiation time needs to be kept as low as possible.

With a FEES assessment, there is no additional radiation, no ingestion of barium, and no trip to the hospital to have all of this done. Instead, you can enjoy my comfortable office with familiar foods and soothing music. As a bonus, a FEES assessment can be repeated as often as needed, used during an entire meal, and even used during treatment as biofeedback.

What should you expect during a FEES assessment?

The FEES assessment is completed in the comfort of my office, ensuring your ease and convenience. You or your family can bring any specific foods or drinks that cause you difficulties at home so that we can see what is happening with those foods specifically. 
During the procedure, you will be seated upright in a regular chair. I will pass a thin, flexible scope through your nose. You may feel a brief pressure when the scope passes through your nose, but this will pass, and you can rest assured that the procedure is designed to be as comfortable as possible.

The FEES assessment has two essential parts. While I place the scope, I will start the evaluation's first phase. I will look at your throat and the various structures while you sit comfortably resting, and then I will observe what is happening while you say several specific sounds and phrases. For example, I will have you say "eeeee" or "Paul is tall."
 
Then, we will move on to the next phase. I will assess how the structures in your throat move when you swallow your saliva without extra foods or liquids. Then, I will have you take sips or bites of different foods/liquids, textures, or consistencies. I use a small amount of food coloring with the foods and liquids to help me visualize how they move inside your throat. During this phase, we may try various strategies, positions, or consistencies, such as swallowing extremely hard or sequencing solid foods with small sips of liquid. These strategies are designed to test your swallowing function under different conditions and to see how well you can adapt to different textures and consistencies of food and liquid.
We will then review the FEES results directly following your assessment, providing you with immediate feedback and support. During this review, I will use the video taken during the FEES to look at single frames or still photos of your swallowing. -- Swallowing is a speedy process. It can take as little as 0.3 seconds for what you're swallowing to move from your throat into your esophagus. Being able to slow down clear pictures of your swallowing is the main reason this assessment is so beneficial.
 
If your FEES test shows you are having problems swallowing, we can create a treatment plan together. I will also make referrals to other specialties as needed. Once the report is written, typically within three business days, a full report will be sent to you and the doctor or therapist who referred you for the test (as allowed by the release of information form).
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