Videofluoroscopy vs Flexible Endoscopic Evaluation of Swallowing
If you or someone you care for are experiencing swallowing difficulties, you know how much it can impact mealtime enjoyment and safety. While assessment of swallowing difficulties generally starts with a Speech Pathologist observing a typical mealtime, when more information is needed, an instrumental swallowing assessment is usually the next step.
Two common instrumental assessments used to explore swallowing issues in more detail are Videofluoroscopy (also known as Modified Barium Swallow Study) and Flexible Endoscopic Evaluation of Swallowing (FEES). Understanding these assessments can help you make informed decisions about your care or the care of a loved one. Let’s take a look at what each assessment involves, how they work, and where you can have one completed.
Why is Instrumental Swallowing Assessment So Important?
Before we get into the details about the different instrumental assessments available, we want to quickly touch on why this type of assessment is so valuable. If you’ve already had an initial assessment during a mealtime, you might be wondering why this extra assessment is needed.
One of the key things that Speech Pathologists look for in swallowing assessments are signs of what’s known as ‘aspiration’ – food or drinks going down the wrong way. While many of us would cough in response to things going down the wrong way (it’s one of our in-built protection mechanisms), in some individuals with swallowing disorders they don’t notice when this occurs and things go down the wrong way frequently without any attempt to cough them out.
Unfortunately, aspiration often leads to a condition called aspiration pneumonia. In people with pre-existing conditions, this can sometimes be fatal. That’s why it’s so important to your Speech Pathologist that, even if they don’t notice any signs of aspiration at first, that they get some further information into what’s going on ‘in the inside’ through an instrumental assessment.
The good news is that research in this area suggests that both Videofluoroscopy and FEES are able to accurately identify if aspiration is taking place, however, FEES was found to be slightly more sensitive than VFSS.
Videofluoroscopic Swallowing Study (Modified Barium Swallow Study/VFSS)
What Is a Videofluoroscopic Swallowing Study?
Videofluoroscopy is an X-ray-based test that allows Speech Pathologists to view the swallowing process in real-time. During this instrumental swallowing assessment, you will be asked to swallow foods and liquids mixed with a special powder (barium). This powder allows the X-ray to capture detailed images of the swallowing process, as it helps the food/liquid to ‘show up’ on the X-ray.
Where Can You Get a Videofluoroscopy?
A videofluoroscopy typically takes place in a public hospital or private hospital or medical clinic that has access to the necessary equipment. Because of this, wait times to have this procedure done can vary.
Flexible Endoscopic Evaluation of Swallowing (FEES)
What Is a Flexible Endoscopic Evaluation of Swallowing?
FEES is an endoscopic procedure that uses a thin, flexible tube with a camera (endoscope) inserted through the nose to visualise the swallowing process. It is a procedure that’s completed while you are seated in a medical clinic setting, and allows for the Speech Pathologist to see food and drinks passing by the larynx through to the oesophagus to make it easier to see if any aspiration is occurring. They may use a blue or green food dye to make it easier to see where food and drinks are going and if there is any leftover residue after swallowing. Unlike videofluoroscopy, FEES does not use radiation.
Where Can You Get a FEES?
A FEES requires specialised equipment and health professionals with the required training to administer it. Much like a Videofluoroscopy, you’ll need to go to a private hospital or clinic in order to access one of these instrumental swallowing assessments.
If you’re based in Brisbane, Speak and Swallow Speech Therapy based in Burpengary are now offering FEES. Find out more here.
Videofluoroscopy and FEES: What’s the Difference?
When to Choose Videofluoroscopy:
- If you need a comprehensive evaluation of the entire swallowing process, including the oral, pharyngeal, and oesophageal phases
- If you require detailed images to assess how different textures and consistencies are managed
When to Choose FEES:
- If you need an evaluation without exposure to radiation, especially if multiple tests are required.
- Assessing the pharyngeal phase of swallowing
- Assessing laryngeal function
- Observing saliva and secretion management
- Visualisation of the mucosa
Both of these instrumental swallowing assessments play crucial roles in diagnosing and managing swallowing disorders. The choice between videofluoroscopy and FEES will depend on your specific needs, the symptoms you’re experiencing, and your treating Speech Pathologist’s recommendations.
If you have any questions or concerns, be sure to discuss them with your Speech Pathologist during your next visit. They can provide guidance tailored to your individual situation and help you understand which procedure might be best for you.