Dysphagia FEES

Everything You Ever Wanted to Know about FEES®

Gray Matter Therapy – a wonderful adult-based therapy blog – recently asked us to write an informational post on FEES for their dysphagia month.  Our post covered what you need to know to get started with FEES and to bring FEES to your facility.  We frequently get emails asking us questions about FEES training, cost/benefit of FEES and comparing FEES vs MBSS, so if you are thinking about FEES training, check out our post here:
Feel free to use our contact box or email us if you ever have any questions – we are always available to answer your questions!
Here’s a chart comparing FEES and MBSS from the post:
What stages of the swallow does it assess? Pharyngeal phase before & after swallow, but can make inferences about oral & esophageal phases Oral, pharyngeal, & cervical esophageal phases
Where can it be performed? Anywhere: clinic, hospital bedside, SNF, pt’s home Hospital radiology suite or mobile radiology van
What pts cannot have the exam? Pts with severe craniofacial trauma. For extremely combative pts, can test compliance by inserting a long Q-Tip at nare entrance Vent pts, severely obese pts, difficult/impossible to transport or position pts.
What are the best indications for the exam? Concern of aspiration of secretions, suspected laryngeal damage, questionable laryngeal sensation, positioning in fluoroscopy problematic, extremely severe dysphagia/concern about any amount of aspiration, fluoro not available, pt transport would put pt at risk or is too expensive, concern about radiation exposure (especially with kids) Need to assess oral stage, need to asses structural movements or submucousal anatomy not visible on FEES (CP opening, cervical osteophytes), suspected esophageal etiology, vague symptoms, no known medical problem, complaint of food “sticking” in throat
What are the limitations of the exam? Cannot see the exact moment during the swallow – a whiteout period occurs.  Therefore must make inferences about this based on what is seen immediately before & after.  Cannot view oral or esophageal stages. To reduce radiation exposure, fluoro is turned on & off throughout the exam and SLP may miss what happens when fluoro is off.  Cannot always test to fatigue due to radiation exposure.  Cannot view laryngeal surface anatomy.  Changes in food consistency secondary to addition of barium.
Bonus material Can assess velopharyngeal closure. Can be used as a biofeedback tool. Can complete an assessment of esophagus.


2 replies on “Everything You Ever Wanted to Know about FEES®”

Who typically cleans the scopes after the FEES. Have had issues at my facility where the SLPs are being asked to reprocess the scope. If you could provide any supporting documentation that would note who should clean the scopes.

Hi Troy. It is not unusual for SPLs to clean their own scopes, but it depends on the facility environment. SLPs in rehab hospitals and nursing care facilities typically clean their own scopes using high level disinfectant. However, most (not all) acute care facilities require sterilization & that is done in the hospital sterile processing department. Both of these processes must follow CDC (2008) guidelines for cleaning endoscopes. This document can be found on the web easily. Secondly, the facilities (both) must follow cleaning guidelines found in the manufacturer’s manual that accompanies the purchase of the scope. Joint Commission will look at the facility’s policies and procedures to insure they are following the CDC & manufacturer’s guidelines. For nursing care facilities, Joint Commission does not survey those facilities, but some state health department survey teams are now beginning to look at FEES in those facilities and how they clean the scopes. It is the facilities’ decision on who will clean the endoscopes: sterile processing or the SLP. This has to be spelled out clearly in the policies and procedures.

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