Speech therapists play an essential role in addressing a wide range of speech, language, and swallowing disorders.
One of the key tools available to clinicians is the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). This pivotal diagnostic procedure offers a detailed look at the swallowing process, helping to accurately diagnose and treat dysphagia (swallowing difficulties).
If you or a loved one is experiencing any swallowing issues, understanding FEES and its benefits can be incredibly valuable.
What Is FEES and What Is It For?
Fiberoptic Endoscopic Evaluation of Swallowing (FEES), also known as Flexible Endoscopic Evaluation of Swallowing, is a diagnostic procedure that uses a flexible tube called a fiberoptic endoscope to visually assess the swallowing process.
FEES allows clinicians (either a trained speech therapist or ear, nose and throat doctor) to evaluate the physiology of swallowing, detect abnormalities, and identify the presence of aspiration (food or liquid entering the airway).
This detailed information obtained from FEES is crucial for developing effective treatment plans tailored to the specific needs of individuals with swallowing disorders.
When is FEES Needed?
FEES is beneficial for individuals of all ages who experience swallowing difficulties and can be performed in various settings, including a hospital room, outpatient clinic, rehabilitation centre, and sometimes even a home setting.
It is often recommended for individuals experiencing symptoms of dysphagia, including:
- Frequent coughing or choking during meals.
- A sensation of food sticking in the throat.
- Unexplained weight loss.
- Recurrent respiratory infections or pneumonia.
- Gurgly or wet voice quality after swallowing.
- Difficulty coordinating breathing and trouble swallowing.
Patients who have also had strokes, neurological disorders, or head and neck cancers are particularly susceptible to swallowing disorders and may benefit significantly from a fiberoptic endoscopic examination.
A fibreoptic endoscopic swallowing study is also particularly beneficial for children with various conditions that affect their swallowing abilities. It is typically advised in the following scenarios:
- Developmental Disorders: Children with developmental disorders such as cerebral palsy, Down syndrome, or other similar conditions often experience swallowing difficulties.
- Premature Infants: Premature babies frequently have underdeveloped swallowing reflexes.
- Structural Abnormalities: Children born with congenital abnormalities in the throat or oesophagus can benefit from FEES.
- Feeding Difficulties: Children who show aversions to feeding or have trouble transitioning to solid foods can greatly benefit from a detailed swallowing exam.
What Are the Benefits of Undergoing FEES Procedure?
Non-invasive Nature
FEES is a minimally invasive procedure that does not require surgery or extensive recovery time. This makes it a safer and more comfortable option for many patients, especially young children who may be anxious about medical procedures.
Real-Time Observation
One of the key advantages of FEES is its ability to observe the swallowing process in real time.
This allows a speech-language pathologist to see exactly what happens when swallowing, providing immediate and detailed feedback. This real-time observation helps identify any issues quickly and accurately.
Detailed Assessment
The high-resolution images captured during FEES offer a detailed view of the throat and larynx. This makes for a more accurate diagnosis and targeted treatment planning, ensuring that the patient receives the most effective care possible.
Are there Risks and Considerations for FEES?
While FEES is generally safe, it does carry some risks.
The patient may have nose bleeds, feel mild discomfort, or have a gagging sensation. In rare cases, the procedure can cause laryngospasm (a brief spasm of the vocal cords).
FEES may not be suitable for patients with severe nasal obstructions, recent nasal surgery, or those who have an extreme sensitivity to the endoscope.
What to Expect During FEES Procedures
Before the Procedure
Fasting is usually not required before the procedure.
The Process
Insertion of the Endoscope
The procedure begins with the insertion of a flexible endoscope through the nose. This endoscope has a tiny camera at its tip, which allows for a close-up view of the throat and larynx.
Observation and Recording
During the procedure, you will be asked to swallow food and liquids of various consistencies. Food and fluids may be dyed to enable better visualization of the materials during the swallow. The speech-language pathologist (SLP) observes and records the swallowing process in real-time. This includes assessing:
- One’s ability to swallow saliva and other secretions, which is crucial for evaluating saliva or mucous management.
- How well breathing and normal swallowing occur together, ensuring food or liquid does not enter the airway during breathing.
- How effectively the airway closes off during swallowing to prevent aspiration, where food or liquid enters the airway instead of the esophagus.
- Any abnormal structural problems in the throat or larynx that may contribute to swallowing difficulties.
The entire procedure typically lasts about 10 minutes, although this may vary depending on individual circumstances.
Post-Procedure Care
After the procedure, you can generally resume normal activities immediately. Some may experience a slight sore throat or nasal irritation, which usually resolves quickly.
Based on the FEES findings, the speech therapist will develop a personalised treatment plan. This plan may include exercises to improve swallowing function, dietary modifications, and strategies to ensure safe eating and drinking.
Comparing FEES to Other Diagnostic Tools
FEES VS Videofluoroscopic Swallow Study (VFSS)
VFSS, also known as a modified barium swallow study, uses X-rays to examine the swallowing process.
While both FEES and VFSS provide valuable insights, FEES has the advantage of being performed without radiation exposure and can be conducted in a more natural eating environment.
It is also beneficial for patients who require frequent evaluations, those who cannot tolerate barium, or when a detailed view of the throat’s soft tissues is necessary.
FEES vs. Manometry
Manometry measures the pressure and coordination of muscles in the esophagus using a catheter inserted through the nose and into the stomach.
While manometry provides critical data on esophageal motility, it doesn’t offer visual insight into the swallowing process.
FEES, on the other hand, allows clinicians to observe the actual mechanics of swallowing, making it easier to identify structural issues and the presence of aspiration.
Take the Next Step: Consider FEES for You Swallowing Needs
Ensuring the ability to swallow safely and effectively is paramount to one’s overall health and well-being. If you or a loved one needs a FEES procedure, you’ve come to the right place!
At Speech Matters, you are in expert hands led by Dr. Phua Sin Yong, an experienced practising speech therapist specialising in cognitive communication disorders and dysphagia.
Dr. Phua introduced FEES into the scope of practice for speech therapists in Singapore in 1997, and has since performed over 5000 FEES procedures and provided extensive training to other speech therapists in the region.
She has also published extensively in peer-reviewed medical journals, contributing significantly to the field of speech therapy.
Choosing Speech Matters means benefiting from a practice that prioritises your well-being, employs state-of-the-art techniques, and leverages extensive experience in managing swallowing disorders.
Trust us to help you achieve better health and improved quality of life through our comprehensive and compassionate approach to speech therapy.