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Myths of FEES Part 4

You know.   You can’t see anything with FEES.   It is painful and dangerous to use FEES to assess your patients.   We’ve already discussed this though in my previous 3 posts, right?

So what’s the last myth we’re going to discuss in FEES?

FEES Myth #4………   But, MBSS (Modified Barium Swallow Study) is the gold standard!

While it is true that the MBSS has been around longer and is widely used far more than FEES, FEES is a gold standard assessment.

FEES is often used to view posterior loss of bolus into the pharynx prior to the swallow, penetration, aspiration, pharyngeal residue, opening of the esophagus and in some cases retrograde backflow from the esophagus into the pharynx.   

With FEES, you are also able to view the laryngeal and pharyngeal structures, giving you a clear picture of the anatomy.   

Susan Langmore has discussed the history of FEES, including simultaneous FEES and MBSS.  Studies that compared MBSS and FEES were often simultaneously completed.

One study found that there was agreement in presence/absence of residue, however FEES rated the residue as worse (greater) with more residue in the pharynx.  Penetration Aspiration Scores (PAS) were higher or worse when rated from FEES.  (Pisegna et al 2016, Kelly et al 2007).

In her article, Dr. Langmore stated, “The results of these ‘simultaneous’ studies argue against the MBS study being the gold standard. The gold standard should represent the truth as close as we can ascertain.  FEES is more sensitive to bolus findings, and in the case of detecting the presence of a bolus, it is clearly superior.”

Both tests have clear value in assessment of dysphagia and both tests should be considered when determining best practice for your patient.   


Langmore, S. E. (2017). History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia32(1), 27-38.

Pisegna, J. M., & Langmore, S. E. (2016). Parameters of instrumental swallowing evaluations: describing a diagnostic dilemma. Dysphagia31(3), 462-472.

Kelly, A. M., Drinnan, M. J., & Leslie, P. (2007). Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?. The Laryngoscope117(10), 1723-1727.

Langmore, S. E. (2003). Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?. Current opinion in otolaryngology & head and neck surgery11(6), 485-489.

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