FEES vs MBSS comparisons seem to be important to some SLPs when making decisions on which instrumental procedure to use with patients with suspected dysphagia. Unfortunately, some clinicians have been erroneously taught that one procedure is better than the other. Some ask, “Which one is the ‘gold standard’ in diagnosing swallowing disorders?” It really comes down to the clinician and what information is needed, and to the patient where they are located, and if they can be transported. In some patient situations, BOTH procedures may be necessary to completely understand the complexity of their disorder. Current clinical literature supports that both FEES and MBSS are their own “gold-standards.” Both exams have significant value in the SLP’s toolbox, and clinical research continues to demonstrate this value, particularly when compared to non-instrumental bedside screening assessments. FEES and MBSS each have unique advantages, disadvantages, and clinical indications, which are outlined below. This chart was created from a combination of resources including Dr. Susan Langmore’s textbook on FEES (Langmore, 2001), SA Swallowing Service’s FEES training course manual (Ashford, 2021), our SASS clinical experience, and clinical literature published primarily in the journal, Dysphagia.
Ashford, J.A. (2021). FEES 2021: Instrumental Dysphagia Assessment. Basic FEES training course manual. Nashville, TN: Author
Langmore, S. (2001). Endoscopic Evaluation and Treatment of Swallowing Disorders. New York: Thieme.
Aviv, J.E., Kaplan, S.T., Thomson, J.E., Spitzer, J., Diamond. B., & Close, L.G. (2000). The safety of flexible endoscopic evaluation of swallowing with sensory testing (feesst): An analysis of 500 consecutive evaluations. Dysphagia, 15, 39–44.
Kelly, A.M., Drinnan, M.J., & Leslie, P. (2007). Assessing penetration and aspiration: How do videofluoroscopy and fiberoptic endoscopy evaluation of swallowing compare? Laryngoscope, 117, 1723-1727.
Brady, S. & Donzelli, J. (2013). The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngology Clinics of North America, 46, 1009-1022.
Pisegna, J.M. & Langmore, S.E. (2016). Parameters of instrumental swallowing evaluations: Describing a diagnostic dilemma. Dysphagia, DOI 10.1007//s004455-016-9700-3, March, 17, 2016.