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Myths of FEES Part 2

This is going to be a big one.

This is going to maybe go against everything you’ve ever heard or known.

I mean, maybe I need a drumroll here……

FEES Myth #2 Busted………

You CAN see aspiration with FEES.

There…..i said it.

“Good agreement was found, especially for the finding of aspiration (90%).” (Regarding FEES) Schatz, Langmore, Olson 1991.  

While it is true, there is that “white-out” phase at the height of the swallow.   Although, sometimes, mine tends to look more green or black than white, you can see.

You can definitely see aspiration before the swallow.  You can see the material spill over the epiglottis and into the laryngeal vestibule.   Sometimes, when you watch close and slow down the video, you can even see the material spill into the laryngeal vestibule as the swallow occurs.

“It was concluded that the clinical examination, when compared with FEES, underestimated aspiration risk and overestimated aspiration risk in patients who did not exhibit aspiration risk.”  Leder, Espinosa 2002.

The thing with aspiration, to be considered aspiration is has to stay at the level of the vocal folds or lower in the trachea.   Now, I’ve been doing swallow studies whether it be MBSS or FEES for many years and I have very rarely seen the material just drop straight through the trachea.   There is residue that can be seen on the vocal cords or into the trachea with aspiration that is not cleared.

You can also typically see secretions or material bubble at the level of the vocal cords as the patient breaths or tries to clear the material.

“This study found that FEES was just as reliable as VFSS when using the PAS.”  Colodny 2002


Leder, S. B., Sasaki, C. T., & Burrell, M. I. (1998). Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia13(1), 19-21.

Schatz, K., Langmore, S. E., & Olson, N. (1991). Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Annals of Otology, Rhinology & Laryngology100(8), 678-681.

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.

Leder, S. B., & Espinosa, J. F. (2002). Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia17(3), 214-218.

Colodny, N. (2002). Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (Fees®) using the Penetration–Aspiration Scale: a replication study. Dysphagia17(4), 308-315.