Fiberoptic Endoscopic Evaluation of Swallow (FEES)

Fiberoptic Endoscopic Evaluation of Swallow (FEES) is an in-office, objective evaluation of swallow function. This instrumental study is performed by a specially trained speech-language pathologist (SLP), laryngologist or ear, nose and throat doctor to determine the cause of the swallowing difficulty (dysphagia) and assist with precise planning of dietary changes and/or treatment modalities.

At Mount Sinai’s Grabscheid Voice and Swallowing Center we have a team of experts who conduct FEES on a daily basis. These swallow studies are conveniently conducted on the same day of the patient’s visit, negating the need for a second appointment.

About the FEES Exam and Its Purpose

During a FEES exam, a flexible endoscope, approximately the diameter of spaghetti and outfitted with a light source and connectivity to video recording equipment, is gently passed transnasally (through the nose) to obtain a superior view of the pharynx and larynx during the swallowing process. This evaluation offers a thorough assessment of both the anatomy and physiology of the nasopharynx, pharynx, base of tongue, larynx and opening of the esophagus at rest, while the patient is voicing, performing other non-speech tasks, and while the patient is eating and drinking.

The structural and functional assessment prior to giving the patient any food or liquids includes checking the integrity of the velum, base of tongue, pharynx, and larynx, as well as assessing symmetry, appearance of tissues, the quality and management of secretions, and any observed food residue at baseline. It also checks velopharyngeal closure, pharyngeal wall movement, laryngeal abduction, adduction, and cough, and can detect any lesions.

After the initial evaluation of anatomy and physiology is performed without food and liquids, the patient is presented with foods and liquids of different consistencies, and the swallow mechanism is observed in real time for any dysfunction, while they are eating and drinking. Any dysphagia, up to the level of the vocal folds, can be identified with FEES, which is sensitive enough to detect trace aspiration and aspiration of secretions - something that a modified barium swallow (MBS) does not pick up.

If swallow dysfunction is observed during the examination, compensatory postures, maneuvers, and diet modifications and their effectiveness will be assessed at that moment in order to improve the safety and efficiency of the swallow. The goal is to maintain the safest appropriate diet.

Benefits of the FEES Procedure

  • In-office procedure
  • View larynx in detail
  • View secretions and mucosa
  • Able to test sensation
  • Immediate results and treatment plan
  • If swallow dysfunction is identified, ability to immediately assess compensatory postures, maneuvers and modifications and their effectiveness
  • Able to detect aspiration of secretions and trace aspiration
  • No exposure to radiation

What to Expect after FEES

The video recording of the endoscopic swallowing study is played back for the patient and reviewed with them during their visit. The exam is explained and the patient is educated about their swallow dysfunction. All questions are answered. The patient is immediately given recommendations and set up for therapy or medical intervention, if warranted.