Myths of FEES Part 3

You don’t use FEES.  Maybe you don’t believe in FEES because you’ve heard somewhere that it’s dangerous.

Myth #3……..FEES is too dangerous for my patients.

I’m pretty sure that if FEES were that dangerous, it wouldn’t still be a thing.  I mean, if we’re doing harm to patients with use of a procedure, it would either be modified to make it safer or would not be a thing at all.

Sometimes, we are so afraid of the unknown and if you have never been exposed to FEES first-hand, you may be a little weary of the procedure.

So, how safe is FEES?

There have been several studies looking at the adverse effects of FEES.   The most common adverse effects can be epistaxis (nosebleed), vasovagal response (faint) or a laryngospasm.

One study looked at 212 patients s/p CVA and other neurological events.  Of these 212, there were SIX cases of epistaxis, no change in vital signs during the procedure, no airway compromise and no laryngospasm.   (Aviv, et al 2000)

Even looking at pediatrics, FEES is a safe procedure.   In a study of 500 pediatric patients, there were only FOUR cases of epistaxis with no case of laryngospasm.   (Link et al 2000)

A review of the FEES literature in 2016 examined 2820 FEES exams finding 4 cases of epixtaxis (.14%), 3 cases of vasovagal syncopy (.1%) and 2 cases of laryngospasm (.07%) all of which spontaneously resolved.  (Nacci, et al 2016)

The risk of FEES appears to be small in the literature.  FEES has been found to be a safe procedure to determine anatomy and physiology of the swallow.


Link, D. T., Willging, J. P., Cotton, R. T., Miller, C. K., & Rudolph, C. D. (2000). Pediatric laryngopharyngeal sensory testing during flexible endoscopic evaluation of swallowing: feasible and correlative. Annals of Otology, Rhinology & Laryngology109(10), 899-905.

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.

Nacci, A., Matteucci, J., Romeo, S. O., Santopadre, S., Cavaliere, M. D., Barillari, M. R., … & Fattori, B. (2016). Complications with fiberoptic endoscopic evaluation of swallowing in 2,820 examinations. Folia Phoniatrica et Logopaedica68(1), 37-45.

Warnecke, T., Teismann, I., Oslenber, S., Hamacher, C., Ringelstein, E.B., Schabitz, W.R., &
Dziewas, R.; 2009. The safety of fiberoptic endoscopic evaluation of swallowing in acute
stroke patients. Retrieved July 18, 2009 from

Aviv, J.E., Murray, T., Zschommler, A., Cohen, M., Gartner, C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1340 consecutive examinations. Annals of Otology, Rhinology & Laryngology. 2005;114:173-176.

Cohen, M.A., Setzen, M., Perlman, P.W., Ditkoff, M., Mattucci, K.F., Guss, J. The safety of
flexible endoscopic evaluation of swallowing with sensory testing in an outpatient
otolaryngology setting. Laryngoscope. 2003;113:21-24.

Wu, C.H., Hsiao, T.Y., Chen, J.C., Chang, Y.C., &Lee, S.Y. Evaluation of swallowing safety
with fiberoptic endoscope: Comparison with video fluoroscopic technique. Laryngoscope. 1997; 107, 396-401.

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