What is FEES?
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is an instrumental swallow study that uses a flexible endoscope. During the exam, the scope is passed through the nose and into the back of the throat where a camera is used to visualize the pharynx, larynx, and upper esophageal opening (i.e. throat and stomach tube). The patient is then given various items to eat and drink in order to evaluate their swallowing function and efficiency, determine safest diet level, determine presence of aspiration, and provide therapeutic and compensatory recommendations. The exam is performed by a qualified and licensed Speech Language-Pathologist (SLP) for patients with dysphagia (medical term for a swallowing disorder).
Is FEES a new technique?
No, it's not! Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a well established technique that has been used in the field of dysphagia diagnostics since the 1980s. FEES is a sensitive, accurate, portable, and safe examination that gives clinically useful information relative to swallowing physiology and swallowing safety. FEES can be done at the patient’s bedside or table, in an office, in an intensive care unit, or in a long-term care facility in under 20 minutes (typically about 15 minutes) with regular foods and liquids. Since there is no radiation used, the swallowing studies are able to be completed for a longer period of time which enables the Speech-Language Pathologist (i.e. Speech Therapist or "SLP") completing the exam greater ability to tell if a patient’s swallowing function is impacted by fatigue.
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Susan Langmore, Ph.D., and colleagues first used the term FEES in 1986. From there, the first data set demonstrating the effectiveness of the procedure was published in 1988. FEES has been readily utilized in hospitals, acute care, and short-term rehabilitation settings since then. FEES is also known by a few other names including: “video endoscopic evaluation of dysphagia” and “bedside endoscopic swallowing test." FEES generally falls within the scope of practice of a Speech-Language Pathologist. More information and research regarding FEES can be found here.
When someone is having difficulty swallowing,
a quick and comprehensive diagnosis is critical.
Why is imaging crucial?
Properly diagnosing swallowing issues can be difficult. Video imaging is essential for accurate and comprehensive diagnosis and recommendations. Imagine it like this: You fell and think you broke your leg. You're going to want x-ray imaging to confirm that and provide recommendations for follow-up (brace, cast, surgery, etc.).
Imaging for swallowing is the same- We need imaging to provide comprehensive assessment and provide recommendations for follow-up. We can't diagnose what we can't see. Visualization of anatomical and pathophysiological deficits enable us to make appropriate recommendations. Once baseline imaging is obtained, we can use our clinical judgement to form a treatment plan.
Can't my team just downgrade to thickened liquids for now?
Sure, we can downgrade, but, ultimately, a long-term downgrade is not the goal and is often not clinically indicated. In fact, some swallowing exercises and strategies, such as thickened liquids, have been shown to actually cause harm to a patient and potentially cause a subsequent re-hospitalization if they are implemented for an unnecessary reason.
E's Mobile FEES knows first-hand the dilemma of residents being “stuck” on pureed foods and thickened liquids, losing weight, and/or suffering an aspiration pneumonia because they are too weak or otherwise medically compromised to travel out of the facility for a swallowing assessment. Onsite Mobile FEES offers a solution to that problem.
The evidence is clear.
Video imaging is crucial for accurate identification of aspiration, especially silent aspiration, and other structural anomalies that impact the swallow. Video imaging provides critical information for the treating Speech-Language Pathologist, physician, and care team.
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Research has shown up to a 70% error rate in bedside swallowing exams where recommendations made were either too restrictive, leading to dehydration/malnutrition, or there was silent aspiration leading to a pneumonia. Even by experienced therapists, bedside and mealtime swallowing assessments alone can only accurately diagnose swallowing function about 60-75% of the time.
On the other hand, research has consistently shown that FEES and MBSS/VFSS have a 97-100% inter-rater reliability with FEES being shown to be higher in specificity and severity in identifying penetration, aspiration, residue, and spillage.
Our FEES Equipment:
At E's Mobile FEES, we use PatCom Medical and their Portable FEES System. PatCom's Portable FEES System is designed to optimize the freedom to perform the FEES exam in a variety of settings while providing the best clinical service to patients. PatCom's software suite and imaging system provides high quality immediate feedback for the most accurate viewing and diagnostics. Please click the link for further information regarding the PatCom Portable FEES System.
