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Fiberoptic Endoscopic Evaluation of Swallowing, commonly referred to as a FEES Study, is a specialized medical procedure that allows doctors to make a direct visual assessment of a patient’s swallowing process. The FEES swallow test is typically used to help diagnose conditions related to problems swallowing (dysphagia)
Fiberoptic endoscopic examination to determine the cause of swallowing issues is conducted using an instrument that looks like a thin, flexible tube, called a laryngoscope. During a FEES test, the laryngoscope is gently inserted through the patient’s nose and into the back of the throat.
The flexible instrument has a tiny camera and light attached at the tip. During the swallowing exam, this allows a speech language pathologist or ear, nose and throat doctor to observe details of the patient’s swallowing function on a video screen.
The FEES swallow test is an important tool in the diagnosis of patients who are experiencing trouble swallowing, also known as dysphagia.
Dysphagia can manifest in various ways, from food sticking in the throat while swallowing to a experiencing a gagging sensation. The FEES procedure helps identify the root cause of swallowing disorders.
By directly observing the swallowing process through the FEES swallow exam, medical professionals can pinpoint areas where swallowing function might be compromised, whether it’s due to a lack of muscular coordination needed to swallow or abnormal structural problems in the throat.
Information gathered during FEES procedures can potentially help physicians find treatment options that can get a patient’s swallowing process working properly again.
Because the patient isn’t sedated during the FEES swallow procedure and may feel mild discomfort as the laryngoscope is inserted through the nose, the test usually begins with a healthcare provider applying a mild, sprayable anesthetic to one of the patient’s nostrils and throat.
Once the numbing has taken effect so the laryngoscope can be inserted to allow the structures of the throat to be viewed by the physician, the FEES test is a two-phase procedure:
First, the healthcare provider conducting the FEES test will usually examine the function and appearance of the oropharynx and larynx without any food present, assessing the patient’s ability to swallow saliva that’s naturally produced in the mouth. This phase of the flexible endoscopic evaluation helps the physician understand the patient’s normal swallowing process and why they might be having trouble swallowing.
In the second phase, the patient is usually asked to eat foods of different textures and sizes, which is sometimes dyed so it can be seen better by the physician. If the patient has reported problems while swallowing specific foods, those foods may be included in this portion of the test.
As the patient swallows, the flexible endoscopic evaluation captures how the patient’s throat handles foods of varying thickness and consistency. This can provide insight into why certain foods and liquids may be causing swallowing issues for the patient.
The FEES swallow test usually only takes about 20 minutes. Patients aren’t required to be sedated during the test, and can usually return to their normal activities and diet immediately afterward unless they’re directed otherwise by their doctor.
However, there are a few steps you’ll likely need to take to prepare for the FEES procedure. Follow your doctor’s instructions, but the steps to prepare for fiberoptic endoscopic evaluation of swallowing generally include:
Discuss any allergies, ear-nose-throat issues or surgeries, and any complications you’ve previously experienced involving anesthetics with your medical provider.
Inform your medical team about all medications you’re currently taking, including prescription and over the counter medications, vitamins and herbal supplements.
Avoid liquids or food before the procedure as instructed by your healthcare provider.
Wear comfortable clothing the day of the test, and avoid heavy makeup or jewelry.
The FEES swallow test is relatively quick, usually lasting around 20 minutes, but how long the test takes can vary from patient to patient. During the test, the patient remains seated in an exam room or hospital room, and stays fully awake throughout the procedure.
To ensure patients only feel mild discomfort during the procedure, an anesthetic nasal spray is usually applied to numb the nose and throat area before insertion of the laryngoscope.
Like all medical tests, the FEES swallow procedure comes with risks. Rarely, some patients might experience a brief closure of the airway, known as laryngospasm, or perforation of the lining of the nose. Other potential complications or adverse reactions include nosebleeds, mild discomfort in the throat or a brief gagging sensation. However, when the FEES procedure is conducted by trained medical professionals, these risks are minimal.
Fiberoptic endoscopic evaluation of swallowing is performed with a medical device called a laryngoscope. It’s essentially a long, flexible tube with a tiny video camera and a light at the end, and allows physicians to directly view the tissues and structures involved in swallowing.
As such, unlike other imaging methods like modified barium swallow, the FEES test doesn’t require x-rays, radiation or radioactive tracer substances to create images.
While the FEES test is a valuable diagnostic tool, it’s essential to understand that it might not be suitable for everyone. Patients with certain medical conditions or those at high risk for complications might need to be diagnosed through alternative tests, such as a modified barium swallow. It’s important to have a detailed discussion with your healthcare provider to determine the best approach.
The FEES swallow test, when performed by skilled medical professionals in a controlled environment, is generally considered very safe.
Sedation isn’t typically required during the FEES test. However, to ensure the patient experiences minimal discomfort, an anesthetic spray is usually applied to the nose and throat. This ensures that the insertion of the flexible instrument used in the procedure is as comfortable as possible.
In most cases, preliminary results are usually available immediately after the procedure. The speech language pathologist or ENT doctor will review the findings more fully, and based on what was found during the evaluation of swallowing, a detailed treatment plan will be devised to address any identified swallowing disorders.