Mobile Swallow Studies/ FEES
SNR is Oklahoma's only mobile swallow study provider board certified by the American Board of Swallowing and Swallowing Disorders, offering the highest level of training and expertise in the field. SNR's owner and chief endoscopist Tiffany Turner is one of the OK/AR/KS region's handful of adult focused board certified swallowing specialists, and the others are primarily in university/ academic settings.
We realize not everyone is able to make it to our clinic, but we wanted the same specialty swallow studies to be available to everyone in need of our services. As a solution to the many inquiries we have received regarding going mobile, we are now providing fiberoptic endoscopic evaluation of swallowing (FEES) procedures to patients in skilled nursing/ home health settings. We are bringing the same top-notch studies that we provide at our midtown Tulsa endoscopy suite for ENTs throughout Oklahoma and surrounding states to your patients' bedside for a more thorough and cost effective solution for your onsite swallow studies.
For facilities interested in contracting for mobile services, please email us at firstname.lastname@example.org.
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 the patient 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 trials of the patient's regular food/ drinks/ medication 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 the patient 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 and are assessed with each of our procedures.
SNR's endoscopist maintains close communication with the treating SLP when completing swallow studies for their patients, acting as an ongoing consultant at no additional charge. The endoscopist will provide the treating SLP with a full detailed report of the study, the endoscopy video, and treatment recommendations for individualized exercises to rehabilitate the swallow.