Instrumental Swallowing Assessment (FEES)

Flexible Endoscopic Evaluation of Swallow

Flexible Endoscopic Evaluation of Swallow (FEES) Testing – What is a FEES Test?

The Flexible Endoscopy Evaluation of Swallow (FEES test) is an invasive bedside test where the endoscope is inserted into the nares and ‘hangs’ above the epiglottis. The FEES test allows direct assessment of motor and sensory aspects of swallowing, visually assesses pharyngeal and laryngeal stages of swallowing and allows observation of pharyngeal muscle movement, epiglottic movement, as well as vocal fold closure to allow management of dysphagia to decrease risk of aspiration pneumonia. A FEES swallow test may need to be issued to patients with difficulty swallowing. 

The FEES test provides objective data that is interpreted and implemented in a cohesive treatment plan for those with dysphagia. Administering a FEES swallow test is a highly skilled service that can only be performed by SLP’s who receive proper training.

FEES Testing

The nature of FEES testing allows the test to be completed on-site with no need for transportation to an appointment or a CNA to leave the facility.

Patients who can be considered for FEES testing could include those who:

  • Complain of trouble swallowing liquid, food, or medication

  • Feel something stuck in their throat or pain upon swallowing

  • Have difficulty swallowing related to a stroke, Parkinson’s Disease, MS, CP, dementia or other neurologic impairment

  • Have a history of reflux

  • Are NPO and may be able to return to oral feedings

  • Currently on an altered diet who may be able to benefit from an upgrade in their diet consistency

FEES Swallow Tests at Language Fundamentals

Language Fundamentals uses its own equipment to complete FEES tests and can perform testing in multiple areas of New York State. A FEES assessment may need to be performed if a patient is having trouble swallowing liquid, food, or medicine. A FEES swallowing test will allow our professionals to evaluate the patient and observe the staging of swallowing in the patient for any causes of discomfort.

Contact us at 845-897-3330 to discuss how FEES testing provided at your Skilled Nursing Facility can be a cost effective and patient friendly service for your patients.

Zenker’s Diverticulum During A FEES Test

See the result of a Zenker’s Diverticulum as seen through a FEES. Reflux is a condition in which the bolus (foods and liquids) leak upwards from the esophagus through the upper esophageal sphincter (UES).

This video shows a good example of what happens to a person when that happens.

Reflux can occur when stomach acid frequently flows back into the tube connecting your mouth and stomach. This acid reflux can irritate the lining of your esophagus.

This process can be seen during a FEES test.

Dysphagia Seen In A FEES Test

Trace aspiration occurs when small amounts of foods or liquids go below the vocal cords. Dysphagia is the technical term for a swallowing disorder or swallowing difficulty.

If a person has food or liquid go into their airway without feeling it, then this is called silent aspiration.

Aspiration can lead to coughing, difficulty breathing, discomfort, and sometimes choking.

A FEES test can uncover objects such as foods or liquids that have gone below the vocal cords causing aspiration.

Cough Reflex During FEES Testing

This video shows premature spillage of liquids that elicit a cough reflex when the liquids touch the vocal cords. The cough is the body’s natural protective reaction to attempt to clear the airway. Coughing is the body’s way of getting food, liquid, and other objects out of the airway and away from the lungs.

If the body feels a hard or liquid object going into the airway, the natural response from the body is to cough.

Penetration is when food or liquid goes into the trachea and stays above the vocal cords.

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FEES Swallow Test

To learn more about FEES testing and FEES swallow evaluation, feel free to contact Language Fundamentals today with any questions!