Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
When dysphagia (or difficulty swallowing) is suspected, an instrumental assessment is necessary to objectively determine the specific structures impaired, the severity of the deficits, the diet/liquid textures that are safest to reduce symptoms, and the specific exercise program that can target the affected musculature to improve swallowing abilities.
We are proud to offer state-of-the-art fiberoptic endoscopic evaluation of swallowing (FEES) procedures to patients at our midtown Tulsa clinic's endoscopy suite or those in skilled nursing/ home health settings via mobile FEES on a case by case basis. SNR's owner and chief endoscopist Tiffany Turner is one of only a handful of adult focused board certified swallowing specialists in the region (and most of the others are primarily in university/academic settings). Board certification by the American Board of Swallowing and Swallowing Disorders requires the most extensive training in the field, and SNR is happy to work closely with several physicians throughout the state to provide the latest evidence-based dysphagia services to Oklahoma and surrounding areas.
About the Procedure
FEES procedures allow for objective assessment of the swallowing physiology via a small painless flexible nasal endoscope.
During a FEES assessment, a small flexible scope with a high resolution digital camera on the end is passed through the nose into the throat to achieve a clear view of the swallowing musculature without interfering with the chewing and swallowing process like an oral scope would. This allows a bird's eye view of the pharyngeal/laryngeal structures and the airway during swallowing to assess for any aspiration, when food or liquid enters the trachea (leading to the lungs) instead of the esophagus (leading to the stomach). While the scope is in place, the speech pathologist will present you with various foods and liquids mixed with green food coloring so they can be easily differentiated from saliva/ secretions.
Currently the two gold standards for evaluating swallowing are fiberoptic endoscopic evaluation of swallowing (FEES) procedures and modified barium swallow studies (MBSS), both of which have their advantages for certain diagnoses. A modified barium swallow study is a video x-ray where radiation is applied during the swallow to view it from the side view.
Since there is no radiation exposure with FEES (unlike modified barium swallow studies), the scope can be left in place longer (e.g., to assess for fatigue throughout a meal) versus only observing a couple bites/drinks. The camera video footage is also left on continuously and is recording the entire time the scope is in place, whereas with modified barium swallow studies the fluoroscopy is quickly turned on and off right before and after the swallow to limit radiation exposure. Having continuous footage throughout the study provides very beneficial diagnostic information since aspiration is most common after the swallow on residue or reflux and next most common before the swallow and can often be missed on a fluoroscopy assessment if the fluoro is turned off immediately before and after the swallow. (See detailed references below.)
Our standard protocol for a FEES assessment includes 12 trials of various consistencies of liquids, solids, and even a "pill". We also encourage patients to bring in their own food if there is a particular item that is causing difficulty.
FEES also allows for high-resolution full color images of the anatomy itself rather than an x-ray view containing only an outline of structures. If any anatomical concerns are noted (e.g., a mass, redness or inflammation, etc.), SNR will refer you to the appropriate specialist to further assess (e.g., ENT or GI). A FEES exam also allows direct visualization of vocal fold movement and of saliva management, both very important factors in aspiration pneumonia risk which cannot be observed via x-ray.
We will provide you with a full detailed report of the study, including images and video clips of relevant findings. SNR will maintain close communication with your physician when completing swallow studies and make recommendations to reduce aspiration risk. Our goal is to determine the best course of treatment for rehabilitating the swallow, making referrals to other specialists when necessary.