Unfamiliar with FEES? Below are some frequently asked questions (FEES FAQ) about this instrumental procedure for assessing oropharyngeal swallowing functions.
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 (see references). 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). Below is a brief synopsis of Dr. Langmore’s discussion of safety, validity, usefulness and efficacy of the FEES procedure.
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“Gold standard” may not be totally accurate for either of the instrumental swallowing assessment studies. Both assessments are not 100% accurate due to many factors including the mediums themselves, clarity of images, time between swallows, clinician perception of event activities, etc. However, as indicated above, both instrumental studies are sensitive and valid. However, when both instrumental assessments are compared to the Clinical Dysphagia (Bedside) Examination, both instruments have far better sensitivity and specificity to detecting aspiration than does the very subjective bedside assessment (Smithard,et al.,1998; Leder & Espinosa, 2002). As Langmore states, both of the instrumental assessment tools “can rightfully be called the gold standard.”
Langmore addresses the issue of SLPs missing medical pathologies, such as cancer, and stresses it is not the purpose of the FEES procedure to identify medical pathologies. SASS clinicians have over 46 years of combined experience, and it is the policy of SASS to report, and if possible, send still-photos of the suspect lesion separately to the nursing facility resident’s primary physician. Further, follow-up endoscopic evaluation by an Otolaryngologist is always recommended.
Langmore, S.E., Schatz, K, & Olsen, N. (1988). Fiberoptic Endoscopic Examination of Swallowing Safety: A new procedure. Dysphagia, 2, 216-219.
Langmore, S.E. (2017). History of Fiberoptic Endoscopic Evaluation of Swallowing for evaluation and management of pharyngeal dysphagia: Changes over the years. Dysphagia, 32, 27-38.
Aviv J.E. (2000). Prospective, randomized outcome study of endoscopy vs. modified barium swallow in patients with dysphagia. Laryngoscope, 100, 563–574.
Kelly, A.M. (2007). Assessing penetration and aspiration: How do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? The Laryngoscope, 117, 1723-1727.
Leder, S.B & Espinosa, J.F. (2002). Aspiration risk after acute stroke: Comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia, 17(3), 214-218.
Smithard, D.G., O’Neill, P.A., Park, C., et al. (1998). Can bedside assessment reliably exclude aspiration following acute stroke? Age and Ageing, 27i(2), 99-106.
Warnecke, t, Teismann, I, Oslenber,S. Hamacher, C, Ringelstein, E.B., Schabitz, W.R., & Dziewas, R (2009). The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients.Retrieved July 18, 2009 from www.stroke.ahajournals.org.
Brady, S. & Donzelli, J (2013). The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngology Clinics of North America, 46(6), 1009-1022.