Myths of FEES Part 1

It seems that everywhere we go, there are myths that are associated with FEES. 

There is always that reason that “I just prefer the MBSS.”  It may be because the MBSS has been performed in your area for much longer than FEES, but there are always other reasons heard on the street.

So, here we go………

FEES Myth Number 1:

It is too painful for my patients.

It’s really not.   If you think about the way we squish and contort our patients at times to fit into the fluoro machine for modifieds, FEES can be just as painless as the MBSS.

There are ways to keep the test pain-free.

Numbing effect

Some clinicians will use a topical anesthetic.  This can be applied to the nare prior to insertion of the scope.  The downfall of using an anesthetic can be that it will eventually travel to the pharynx and may cause a numbing effect in the pharynx, thus affecting the swallow.

The grass may be greener on the other side.

It is important to explore both nares prior to insertion of the scope.   This way, you can find the path of least resistance.   Many people will have one nare that is more narrow than the other, they may have a deviated septum or there may just be some type of obstruction there.

Size does matter.

You may consider the size of your scope.   Scopes are available in various sizes and depending on the scope you use, you may be able to purchase a pediatric scope which will be more comfortable for your patient.

Anecdotal Corner

I have been doing FEES for some time now.   It seems that the biggest fear with the test is the unknown.  Most patients are nervous about the test because they’ve never had something in their nose like that.   After the test, most of these patient’s will also state that they mostly felt pressure in the nose and it was not painful.

Now, that’s not to say that there are not those overly anxious people that start screaming before you even step up to their bedside.

I’ve been scoped multiple times and I’ve even scoped myself and have walked away unharmed all times I’ve been scoped!


Leder, S. B., Ross, D. A., Briskin, K. B., & Sasaki, C. T. (1997). A prospective, double-blind, randomized study on the use of a topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy. Journal of Speech, Language, and Hearing Research40(6), 1352-1357.

Hiss, S. G., & Postma, G. N. (2003). Fiberoptic endoscopic evaluation of swallowing. The Laryngoscope113(8), 1386-1393.

Fife, T. A., Butler, S. G., Langmore, S. E., Lester, S., Wright Jr, S. C., Kemp, S., … & Rees Lintzenich, C. (2015). Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients. Annals of Otology, Rhinology & Laryngology124(3), 206-211.

Aviv, J. E., Kaplan, S. T., Thomson, J. E., Spitzer, J., Diamond, B., & Close, L. G. (2000). The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia15(1), 39-44.


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