Unfamiliar with FEES?  Below are some frequently asked questions (FEES FAQ) about this instrumental procedure for assessing oropharyngeal swallowing functions.

What is FEES?

FEES or Fiberoptic Endoscopic Evaluation of Swallowing is an instrumental procedure to assess the safety and efficiency of, primarily, the pharyngeal stage of swallowing.  Susan Langmore, Ph.D, developed this procedure in the 1980s as an alternative, or adjunct, to the videofluoroscopic swallow study. She, along with Olson and Schatz, published the first paper describing the procedure in 1988. This was only five years after the first publication on videofluoroscopy assessment of swallowing in 1983 by Dr. Jere Logemann. For the historical development of this procedure, read Dr. Langmore’s excellent 2017 paper, History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years, in the journal, Dysphagia.  As this paper and others point out, FEES has gained undeniable credentials as a reliable, valid and safe procedure for assessing oropharyngeal swallowing functions. This is particularly significant for patients who cannot be transported, such as those on ventilators, in isolation, in intensive care in hospitals, and for residents in nursing care facilities.  Today, FEES is considered a “gold standard” in the assessment of swallowing functions. Dr. Langmore published an excellent earlier review paper, found at the website: http://www.nature.com. In addition, well over 100 references to FEES and its use can be found on the Pubmed website (www.ncbi.nlm.nih.gov).

Who can administer FEES?

FEES, in the United States, is usually administered by a certified Speech-Language Pathologist who has received formal and specialized training and who has received direct training and supervision from a FEES licensed or certified SLP.  Licensing may be through individual state licensure requirements, while certification is awarded by the formal training entity who has authorized continuing education privileges from the American Speech-Language-Hearing Association.

What authorities govern the use of FEES by SLPs?

Individual state boards of health only.  Each of the 50 states, through state statutes, provides SLPs the privilege of practicing through licensure, which includes assessment and treatment of swallowing disorders, and, in some cases, specifically the use of MBSS and FEES.  ASHA and other professional organizations do not have direct regulatory authority.

Do I have to have an Otolaryngologist or other physician present when I administer a FEES study?

No.  If you have been properly trained and are competent in the use of a nasoendoscope and the administration of FEES, physician or other health care personnel are not required to be present during the study.  You are not a technician but a medical professional with unique training and expertise. Some state laws, not all, require “medical back-up,” or that FEES, because it is an invasive procedure, should be administered in a setting where medical personnel are available in the event of a medical emergency.  FEES administration is an established part of the SLP’s scope of practice, as stated by ASHA.

Is FEES equipment expensive?

Yes, and it should be if it designed, manufactured, and setup to properly perform the FEES procedure. Endoscopy units designed for Otolaryngologists or Pulmonologists are not made for FEES and SLPs. Usually that equipment is stationary and not moved.  Sharing equipment with another medical entity is very problematic.   Factors to considered when buying FEES equipment: (1) Purchase equipment designed for FEES from a vendor who knows about FEES.  This unit will have everything needed to record and archive excellent quality studies.  Never cut corners, such as using an old computer and installing new software.  Never works without headaches.  Have the vendor come and demonstrate the equipment to you.  Have them scope themselves so you can see the image. If the vendor does not want to come to show the equipment, then do not consider that equipment, regardless of perceived reputation and recommendations.  Poor representative response is a sign of poor response and service needed later; (2) The equipment must have video AND audio recording functions.  Not all do as standard equipment. Audio is just as important as video for this instrumental study.  Analog recording is old technology and digital technology provides a better end product for viewing and analysis; (3) The recording system must have slow motion playback, stop action and frame-by-frame viewing functions.  These are required to analyze swallows with a duration of 3 seconds; (4) Digital endoscopes are much preferred over fiberoptic endoscopes.  Image quality is superior without pixelation and is considerably brighter.  Always purchase TWO endoscopes-when one is dirty or broken, the second scope allows continued patient care; (5) Portability may be the most important factor in FEES equipment.  Regardless of setting, FEES is designed to be taken to the patient, particularly in ICU or COVID wards or nursing homes.  It should be light-weight for easy lifting and moving; and (6) Hospital system now want the video recorded study to be entered into the patient’s medical record.  With most reputable FEES vendors and their systems, this is a standard function.


If you have further questions, please contact SASS at info@sasspllc.com.