Or maybe the question should be, why not FEES?
For so long, Modified Barium Swallow Studies (MBSS) have been considered the gold standard.
The thing is, FEES has been the red-headed stepchild of swallowing evaluation for quite some time. FEES is gaining traction in the SLP world.
So why would you consider FEES?
- You can assess saliva/secretion management-From the time the scope enters the pharynx, you can assess if there are secretions in the laryngeal vestibule. You can see if the patient is aspirating their own saliva and if they are able to clear secretions with cues or with spontaneous swallows.
- You can assess the laryngeal/pharyngeal structures-While you may be able to see that there is something present in the pharynx or the larynx with an MBSS, FEES allows you to visualize the structures to see if they are moving (such as basic movement of the vocal cords) and if there are any changes to the structures affecting the ability to swallow.
- You can still assess the pharyngeal stage of the swallow-You may not be able to see at the height and full closure of the swallow, you can see the bolus spill over the epiglottis, before it inverts, when the bolus falls into the pharynx prior to initiation of the swallow, pharyngeal/laryngeal residue and retrograde flow from the esophagus into the pharynx.
- You actually can see aspiration-So, maybe you can’t see the aspiration at the time, but you CAN see the residual aspiration in the trachea or on the vocal cords.
- You can see penetration-You may have to watch carefully, multiple times, but you can often see the bolus penetrate into the laryngeal vestibule prior to or after the swallow.
- FEES can be done ANYWHERE-The patient can literally be in bed, at the table or lounging on the couch. The FEES equipment is portable and can go right to the patient.
- There’s no barium.-There may be a handful of people that actually like the taste of barium, but I don’t think there are many. FEES can be done with any type of food, usually with green food coloring added. You can watch as many consistencies as necessary while the patient can tolerate the scope in their nose.
FEES can be a valuable asset and resource in your dysphagia toolbox. It’s time we give FEES the same respect we give the MBSS.
Lim, S. H., Lieu, P. K., Phua, S. Y., Seshadri, R., Venketasubramanian, N., Lee, S. H., & Choo, P. W. (2001). Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia, 16(1), 1-6.
Colodny, N. (2002). Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (Fees®) using the Penetration–Aspiration Scale: a replication study. Dysphagia, 17(4), 308-315.
Schatz, K., Langmore, S. E., & Olson, N. (1991). Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Annals of Otology, Rhinology & Laryngology, 100(8), 678-681.
Nacci, A., Ursino, F., La Vela, R., Matteucci, F., Mallardi, V., & Fattori, B. (2008). Fiberoptic endoscopic evaluation of swallowing (FEES): proposal for informed consent. Acta Otorhinolaryngologica Italica, 28(4), 206.
Leder, S. B., Sasaki, C. T., & Burrell, M. I. (1998). Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia, 13(1), 19-21.
Hiss, S. G., & Postma, G. N. (2003). Fiberoptic endoscopic evaluation of swallowing. The Laryngoscope, 113(8), 1386-1393.
Kelly, A. M., Drinnan, M. J., & Leslie, P. (2007). Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?. The Laryngoscope, 117(10), 1723-1727.