Using instrumental swallow evaluation (FEES or MBSS) is essential to correctly diagnosing and treating dysphagia. Using perceptual means at bedside (listening and watching to how a patient sounds or looks alone), is well documented to incorrectly assess presence and severity of dysphagia. Typically SLPs underestimate the presence and severity of dysphagia without use of instrumental assessments.

Placing patients on thickened liquids without the use of instrumentation puts them at increased risk of pulmonary inflammation. Patients are also more likely to silently aspirate thickened liquids than thin liquids. Use of thickened liquids also increases risk of inadequate fluid intake. We should not be thickening liquids without use of instrumentation to determine actual safety and necessity.

Further, in the healthcare setting, instrumental swallow evaluations help reduce overall medicare costs related to re-hospitalizations.

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FEES and MBSS are both regarded as “gold standard” assessments in the evaluation of dysphagia. Studies show good agreement between the two tests when examining penetration, aspiration, residue, and timing of the swallow.

FEES has been shown to be equally, or potentially slightly more, sensitive than MBSS in identification of aspiration. While both exams have some benefits and limitations, both yield necessary information for clinical treatment of dysphagia.

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Potential risk of FEES assessments include epistaxis, laryngospasm, and vasovagal response. The rate of complications is less than 1% overall, and the most prevalent risk is mild epistaxis. FEES is proven to be safe and well tolerated for assessment of swallow when performed by an adequately trained SLP.

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