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.