Frequently Asked Questions

What is FEES?                                                                                                      

FEES, or Fiberoptic Endoscopic Evaluation of Swallowing, is an instrumental procedure to assess the safety and efficiency of the oropharyngeal stages of swallowing.  Susan Langmore, Ph.D, developed this procedure in the 1980s.  Over the years FEES has been deemed a reliable, valid, and safe procedure for assessing oropharyngeal swallowing function.  FEES is considered one of the gold standard means of assessing dysphagia.                                                                                 

FEES is performed using a small flexible scope passed through the nasal passage and hovers over the pharynx to view the larynx, pharynx, and upper esophageal opening via high quality fiberoptic technology. Patients are presented with a variety of different liquids and solid textures that have been tinted with blue, green, or white food coloring. This allows for accurate interpretation of a variety of physiological issues, including but not limited to laryngeal penetration, aspiration, and/or presence of  residual material before, during, and after  intake of food and liquid, which may impact overall health and quality of life.                                                                                                                

FEES can be performed on many patient populations, including medically complex and fragile patients,  who have undegone tracheostomy and/or ventilator dependent persons, those on isolation precautions, morbidly, and those with dementia.

Clinical advantages of using FEES include:

*Seeing an actual picture of the patient’s swallow function
*There are no time constraints during FEES examinations, allowing for an in-depth and thorough evaluation of swallow function
*Allows for immediate determination of the safest and least restrictive diet texture
*Compensatory swallow strategies can be implemented during the procedure with real time feedback of the patient’s response, to view the effectiveness of interventions
*Early detection of dysphagia can reduce the risk for rehospitalization
*Patient’s personal food preferences can be accommodated for the most realistic outcomes
* Well-established, ASHA supported procedure that has consistently provided sensitivity equal to or greater than Video Fluoroscopic Swallow Studies/ Modified Barium Swallow Studies (VFSS/MBSS) in determining the risks and/or presence of laryngeal penetration and aspiration

Who Performs FEES?

A licensed Speech-Language Pathologist who has received formal and specialized training.  A FEES competent individual has been mentored in both performing the procedure as well as interpretation of a variety of normal and abnormal exams, and thorough report writing.  This individual gains the title of Endoscopist once deemed competent.  A physician is not mandated to be present during the evaluation in many states, including Illinois.

What are the clinical advantages?

• See an actual picture of your patient’s swallow function and actively participate in a diagnostic swallowing procedure while providing billable treatment. There are no time constraints during FEES examinations, allowing for an in-depth and thorough evaluation of swallow function

• Allows for immediate determination of the safest and least restrictive diet texture. Compensatory swallow strategies can be implemented during the procedure with real time feedback of the patient’s response, to view the effectiveness of your interventions. Early detection of dysphagia can reduce the risk for (re)hospitalization

• Food served in the facility is used during the exam for the most realistic outcomes. Patient’s personal food preferences can be accommodated. There is no use of barium

• Medically complex scenarios, such as tracheostomies, use of mechanical ventilation, isolation, and those confined to the bed are able to participate in the exam on site without leaving the building

• Well-established, ASHA supported procedure that has consistently provided sensitivity equal to or greater than Videofluoroscopic Swallow Studies/ Modified Barium Swallow Studies (VFSS/MBSS) in determining the risks and/or presence of laryngeal penetration and aspiration

• Cost Effectiveness! Reduces the cost of transporting patients to the hospital and the need for sending nursing staff with the patient. The facility pays a flat fee per procedure and can be reimbursed by the patient’s payor source; CPT codes are provided for the billing department to submit for reimbursement. Also, the cost associated with pre thickened liquids and tube feeding formula is significantly decreased if a diet upgrade is recommended