6 Benefits of FEES Swallowing Assessment

There are many ways to assess swallow function, but one of our favourites as Speech Pathologists is FEES. A FEES swallowing assessment is a non-invasive procedure that allows health professionals like Speech Pathologists to see the functional aspects of swallowing in real-time. Keep on reading to discover six benefits of FEES swallowing procedures and learn how you or someone you care about may benefit from one.

What is a FEES?

FEES is an acronym that stands for Flexible Endoscopic Evaluation of Swallowing. During this procedure, a small tube, called a nasendoscope is placed in one nostril and directed to the back of your throat. You will then be asked to try a range of foods and drinks to see which is easiest and safest for you to swallow. These may be coloured with white, green, or blue food dye to provide a clear contrast on images. This procedure takes approximately 20 minutes to complete.

After your procedure, a Speech Pathologist will discuss your results and develop a management plan for you. This may involve a formal examination and diagnosis by a Respiratory Physician and/or an Ear Nose and Throat Specialist. Speak and Swallow often work alongside Dr Elizabeth Hodge, based in Brisbane, and Dr Paul Paddle and Dr Anthony Rotman from Melbourne Swallow Analysis Centre to assist this process.

Flexible Endoscopic Evaluation of Swallowing procedures at Speak and Swallow will take place in a purpose-built clinic area, meeting infection control standards and fitted with specialised equipment. Speak and Swallow use the EndoCOMPACT Veezar system by XION, which is TGA approved and trusted by both ENTs and Speech Pathologists globally.

The Benefits of FEES Swallow Assessments

There are many benefits to having a FEES swallowing assessment completed. If you or someone you care for have swallowing difficulties, a FEES instrumental assessment may be right for you.

#1: FEES Offers Real-Time Visual Feedback + Biofeedback

One of the most significant benefits of FEES is that it provides real-time visual feedback of the swallowing process. FEES uses a camera to capture video of the throat as someone swallows various textures of food and liquids. This allows the Speech Pathologist to assess the swallowing function with different consistencies, providing a clear picture of the factors contributing to swallowing difficulties.

During a FEES, your Speech Pathologist can trial different techniques to help make swallowing safer for you. These strategies can help to improve your swallow function or minimise adverse reactions when swallowing. By trialing these strategies with the camera in place, your Speech Pathologist will be able to see which technique is most effective in improving your safety when swallowing different foods and fluids. They’ll also be able to let you know when the technique is being performed correctly, so you have instant biofeedback to let you know you’re on the right track.

#2: No Radiation Exposure

If you’ve had an instrumental swallowing assessment before, it is likely that you had a videofluoroscopy (VFSS), also known as a modified barium swallow study (MBSS) that requires the use of an X-ray to visualise swallowing function. One of the major benefits of is that it doesn’t involve any radiation. For individuals who require multiple swallow assessments, particularly those with chronic swallowing difficulties or progressive neurological conditions like Parkinson’s Disease, this is an important advantage!

#3: Visualisation of the Pharyngeal Phase of Swallowing

While VFSS is still an important form of instrumental swallowing assessment, FEES is known for being able to provide a detailed view of the pharyngeal phase of swallowing—the part of the swallowing process that occurs after food or liquid enters the throat and before it reaches the oesophagus. This visualisation of the pharyngeal swallowing phase is critical for identifying issues such as aspiration (when food or liquid enters the airway), residue (food or liquid left in the throat after swallowing), and incomplete airway closure, all of which can contribute to an infection called aspiration pneumonia and other complications. While VFSS can also assess these factors, FEES has been shown to be more effective at identifying both aspiration and penetration.

#4: Assessment of Secretions and Sensory Function

Another advantage of FEES swallowing assessments are their ability to assess clearance of secretions from the throat. Many individuals with dysphagia struggle with managing their saliva, which can contribute to choking or aspiration. In addition to secretion management, FEES can provide information about the gross sensory function of the throat and airway. By assessing how the pharynx responds to stimulation, clinicians can determine whether patients have intact or impaired sensory feedback during swallowing, which is crucial for treatment planning.

#5: Trial Foods and Drinks Without Changing the Taste – No Barium!

If you’ve had other instrumental swallowing assessments in the past, you may have been given foods and drinks that had been mixed with a powder or liquid to help them show up on X-ray. Unfortunately, barium powder has a chalky taste that can really put a damper on your swallow assessment experience – changing the taste of the foods and drinks you need to swallow.

One of the benefits of a FEES is that we don’t need to make any adjustments to the taste of the food and drinks you are trialing – all we do is add some coloured food dye, and you’re ready to go! It definitely makes a big difference to the overall experience of your swallow assessment and won’t leave a chalky taste in your mouth.

#6: Immediate Results

FEES swallowing assessment provides immediate visualisation of the throat when swallowing, allowing clinicians to make real-time decisions regarding which food and drinks are best tolerated by individuals with dysphagia. This is particularly beneficial in clinical settings where quick decisions need to be made about the person’s swallowing function and dysphagia management. At Speak and Swallow Speech Therapy, we support a lot of individuals with progressive neurological disorders who need to have their swallowing function re-assessed often. After a FEES procedure, we update their mealtime management plan to ensure they continue to have safe and enjoyable mealtimes.

Flexible Endoscopic Evaluation of Swallowing (FEES) is a powerful instrumental assessment used in the diagnosis and management of dysphagia. Its ability to provide real-time, detailed visualisation of the swallowing process, coupled with its lack of radiation and accuracy in identifying aspiration, makes FEES swallowing assessment an invaluable option for Speech Pathologists.

If you or a loved one is experiencing swallowing difficulties, it’s worth asking your GP whether FEES is an appropriate option for swallow assessment. As swallowing issues can have serious health implications, early detection and intervention are crucial for preventing complications and ensuring safe and enjoyable mealtimes.