Both FEES and Modified Barium Swallow Studies (MBSS) are gold standard diagnostic tests to assess dysphagia. Both tests assess for aspiration and aid in determining the source of swallowing difficulty. The two tests utilize different technology and viewpoints to gather this information. Neither test is inferior or superior to the other, and often either test can be used to assess swallow function and yield the same diagnostic information. In a few cases, a FEES or MBSS may be preferable over the other depending on the clinical question.

FEES allows for eliminating radiation exposure and is safe for longer or repeated tests, allows for natural foods to be used in the test that do not contain barium, and allows for the visualization of tissues and secretions in the throat (if a patient has trouble even swallowing their saliva).

Because it does not require fluoroscopy (x-ray) equipment or the presence of a radiologist, it is also ideal to assess those who are bed bound, those who typically eat in bed, those who can’t be easily transported, or those who are more medically fragile.

Due to independence in SLPs performing this procedure without direct physician oversight, it also offers a more cost effective solution for swallow assessment. This is particularly significant in non-hospital settings.

Yes! According to current medical literature, FEES is slightly more sensitive in detecting penetration and aspiration when compared to MBSS.

It is true that their is a brief (approximately four tenths of a second) period of “white out” when the soft palate lifts and throat muscles squeeze that block the view of the swallow. However, aspiration is still easily detected by visualizing the airway prior to the swallow and immediately following the swallow.

In order to ensure we are visualizing all we can, all food and liquid consistencies are dyed  with food coloring in order to improve their visibility in the throat. Immediately following each swallow, the camera is moved into the top of the airway where we can visualize whether or not any dye is present in the trachea under the vocal folds (aspiration), or in the top of the airway (penetration). If penetration or aspiration is occurring before the swallow, this is also clearly visualized on camera prior to the “white out” period.

Because the camera is on and recording for the study, we also see everything that happens between swallows as well, which is different from MBSS due to need to limit radiation exposure. This allows us to watch for any aspiration occurring after the swallow due to movement of any residue left in the throat, or any material coming back up through the top of the esophagus.

Risks associated with a FEES procedure are minor and occur in less than 1% of cases, primarily consisting of slight bloody nose or temporary discomfort. See the “Evidence and Literature” portion of this website for full articles regarding risks.

Pain medications and numbing agents are  are not routinely used due to generally excellent  tolerance of the procedure without these measures. Because we can use the scope to see where we are going, we steer the scope in along the most comfortable route in the nose.

Water based lubricant is typically used in our studies to make the scope “slip” through the nose more easily.

Even in a variety of patient populations (skilled rehab, trach/vent patients, dementia patients), tolerance is very good.

There are a few contraindications for FEES. This includes any recent facial, maxillary, or nasal fracture (must be approved by physician or surgeon prior), history of severe nose bleeds (epistaxis), hemophilia, or known bilateral nasal obstructions.

The following are NOT contraindications and do not prevent a patient from FEES participation: isolation precautions, medical complexity, dementia, presence of feeding tubes (nasogastric or gastric), supplemental oxygen, tracheostomy tubes, ventilator dependence (if approved by the physician). If a patient cannot sit upright for a test, FEES can be completed with the patient partially reclined or reclined according to their limitations.

The purpose of a FEES may be initial evaluation of swallow function after a significant medical event or change in function, or it may be to re-assess function following a period of therapy. In either scenario, if your patient is alert and able to attempt to swallow saliva or food/liquid  trials- they are appropriate for a FEES! It is helpful if the patient is at a point where they can follow commands, however inability to follow commands due to dementia or cognitive-linguistic deficits does not preclude participation, as long as they are participating in trials of intake with the SLP.

If you are concerned about the respiratory status or trach/vent status of your client, please contact us with any questions and we can help guide you in determining your patient’s appropriateness.

If you are worried about your patient’s ability to tolerate the exam, our team can assist your SLP in administering a “Q-tip test” in which the patient is screened for behavioral and physical tolerance of a small object entering their nose.