What is a FEES Study?
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is an instrumental examination of the oral and pharyngeal (aka, throat) phases of the swallow that can be performed at bedside with the patient. It was developed by Susan Langmore, PhD, CCC-SLP in 1986 as a more portable, efficient and alternative option to the traditional videofluoroscopic evaluation of swallowing (i.e., Modified Barium Swallow study/MBSS), that is completed in conjunction with Radiology.
FEES is completed by the Speech Language Pathologist (SLP), after obtaining a written order from the patient’s physician. It is within the SLP’s scope of practice as defined by the American Speech-Language Hearing Association (ASHA) Flexible Endoscopic Evaluation of Swallowing (FEES). The study can be completed at the patient’s bedside or chairside, in their own environment or home, eliminating the need for them to be transported to a separate facility. A small, fiberoptic scope with a camera on the end of it is passed gently through one of the patient’s nares and positioned in the back of their throat. This positioning provides the clinician with a superior view of the patient’s pharynx (i.e., throat) and larynx (i.e., voice box/ vocal cords). The scope remains in place throughout the study and the patient is presented with various consistencies of food and liquid, dyed green or white. The assessment allows for an ‘in-the-moment’ evaluation of the patient’s feeding and swallowing safety and essentially combines the clinical swallow evaluation, instrumental swallow study and mealtime observation into one. During the study, the Speech Pathologist may ask the patient to perform certain compensatory strategies and/or swallowing maneuvers in an attempt to improve the safety and efficacy of the swallow. (Langmore, Schatz & Olsen, 1988; Langmore, 2001)
When is a FEES Indicated?
FEES can safely be performed with either pediatric or adult patients who are experiencing swallowing difficulties. If a patient’s pharyngeal swallow is suspected to be impaired, dysfunctional or a concern of aspiration on food, liquid, saliva or esophageal backflow is present, then a FEES would be indicated. In addition, FEES can be utilized if the Speech Pathologist has concerns about the patient’s secretion management or vocal cord mobility.
Patients Appropriate for FEES
Individuals who present with swallowing dysfunction due to the following diagnoses may be appropriate for a FEES:
- Stroke
- Progressive neuromuscular diseases (e.g., Muscular Sclerosis, Muscular Dystrophy)
- Parkinson’s Disease
- Bronchopulmonary Dysplasia
- Head Neck cancer
- Trach and/or vent dependent
- Recurrent pneumonia
- Amyotrophic Lateral Sclerosis (ALS)
- Dementia
- COPD
- Chronic Cough
- GERD
Individuals who are NPO (i.e., Nothing by Mouth) or are on a modified diet consistency due to one or more of the afore-mentioned diagnoses, and wish to return to oral feeds are candidates for a FEES.
Advantages of FEES
FEES is portable and can be performed in the patient’s typical environment. There is no need for the patient and/or support staff to travel or be transported to a separate facility for the study or coordinate with a Radiology department. There is no exposure of the patient to radiation/fluoroscopy and the study is more cost effective as there is no charge for barium or physician time. Secretion management and vocal cord mobility is able to be accurately assessed utilizing a FEES. The patient can eat typical foods and liquids, and the impact of fatigue on the swallow mechanism can be determined over the course of a meal since there are no time constraints as there are with a Modified Barium Swallow study. FEES can be used for biofeedback during therapy to provide the patient with direct information about their swallowing progress. Immediate results of the study will be provided and reviewed with the patient, their caregivers and medical staff. A full report will be written and completed within 24 hours of the study, for submission to the patient’s medical record.
Cost Savings to your Facility with FEES
The financial benefits of offering FEES to the patients in your facility include:
- No cost to transport the patient to the hospital for an instrumental swallow study.
- No need for a support staff person to go off-site to accompany the patient to their swallow study.
- Patients are able to participate in their scheduled therapy sessions that day, without interruption.
- Primary Speech Pathologist can be present for and assist with the study.
- Facility Speech Pathologist can bill for dysphagia treatment the SAME DAY as the FEES.
- Improved formal assessment of the oropharyngeal swallow mechanism can result in reduced incidence of aspiration pneumonia, reduced need for expensive antibiotics, hospital admission, modified diet textures, thickened liquids or tube feedings.
Procedure for Facility Scheduling a Mobile FEES
- Contact Rochester Feeding & Swallowing Therapy SLP, PLLC at (585) 270-1879 or email erin.mccarthy@rocfst.com to discuss signing a contract to consult with your facility.
- Referring facility physician(s) will write an order for “FEES to be completed with Rochester Feeding & Swallowing Therapy SLP, PLLC”.
- Facility will request an appointment for study to be completed. All studies will be completed within 7 days of request.
References
ASHA - Flexible Endoscopic Evaluation of Swallowing.
https://www.asha.org/practice-portal/clinical-topics/pediatric-feeding-and-swallowing/flexible-endoscopic-evaluation-of-swallowing/
Langmore, S. E. (2001). Endoscopic evaluation and treatment of swallowing disorders. Thieme.
Langmore, S. E., Schatz, K., & Olsen, N. (1988). Fiberoptic endoscopic examination of swallowing safety: A new procedure. Dysphagia, 2(4), 216–219. https://doi.org/10.1007/BF02414429
