Fiberoptic Endoscopic Evaluation of Swallowing
What is fiberoptic endoscopic evaluation of swallowing?
A fiberoptic endoscopic evaluation of swallowing (FEES) test is a procedure used to
assess how well you swallow. During the procedure, a speech-language pathologist (SLP)
or an ear, nose and throat doctor (ENT or otolaryngologist) passes a thin, flexible
instrument, called a laryngoscope, through your nose. Then the doctor views parts
of your throat (oropharynx and larynx) as you swallow.
When you swallow food or liquid, it passes through your mouth and down through parts
of your throat called the pharynx and larynx. From here, the food or liquid passes
through a long tube (esophagus) before entering your stomach. This movement requires
a series of actions from the muscles in these areas. It also requires coordination
with the muscles of breathing, since breathing pauses during a swallow.
When you breathe, air passes through your pharynx and larynx, too. It then travels
down through a long tube called the trachea before it reaches your lungs. There is
a small piece of tissue called the epiglottis that acts like a flap and covers your
trachea when you swallow food or drink. This is so food and fluids don't go into your
trachea and lungs.
A FEES test can help assess if you are having any problems with any part of this process.
A FEES test uses a flexible tube called a laryngoscope, sometimes called an endoscope.
This instrument has a tiny camera and light attached to it. Before the FEES test,
you may have something sprayed in your nose or throat to help numb the area so you
don't feel the tube being gently inserted. Your doctor will pass the laryngoscope
through your nose and into your pharynx. It sits above your epiglottis for most of
the viewing and then is can be moved down after each swallow so the vocal folds may
be seen. The laryngoscope allows your doctor to see parts of your larynx, oropharynx,
and trachea on a video screen.
The FEES test has two basic parts. During the first phase, the structure of the oropharynx
and larynx is usually observed. The doctor will watch how well you swallow saliva
before any food. The second part of the FEES test is when food is introduced. Here
your swallowing will be assessed with different textures and sizes of food and liquid.
Your doctor may use food color to dye the food and liquid so it's easier to view on
screen. You may need to change positions or try different types of foods as your doctor
evaluates your throat and swallowing function.
Why might I need a fiberoptic endoscopic evaluation of swallowing?
You may need this test if you have trouble swallowing (dysphagia). With dysphagia,
something goes wrong with the muscular coordination needed for normal swallowing.
Dysphagia can lead to food or fluid going into the airways or lungs (aspiration).
This can lead to pneumonia and other problems. Because of this, it’s important to
promptly identify and treat your dysphagia if you have it.
A FEES test can help your doctor identify what parts of your throat and mouth might
not be working well. The FEES test can also show if there are certain foods or liquids
you need to avoid, or if certain positions can help you swallow more safely. The FEES
test can also show if you are aspirating.
You might need a FEES test if you have any symptoms of dysphagia, like a sense of
food sticking in your mouth or pain with swallowing. You also might need a FEES test
if you have a medical condition that puts you at high risk of dysphagia, even if you
don’t have symptoms. Some people with dysphagia don’t have any symptoms. For example,
if you have had a stroke, someone will need to check to see if you have dysphagia.
This might require getting a FEES test. Other conditions that might cause dysphagia
Head and neck cancer
Conditions that lead to decreased saliva such as Sjögren syndrome
Parkinson or other nervous system conditions
Obstruction in the esophagus such as from cancer
In many cases, an SLP will first assess your swallowing with some simple tests. You
may need to swallow and move your mouth in certain ways. The SLP checks if certain
kinds of substances seem to give you difficulty. Based on the results of this swallowing
exam, your SLP or ENT doctor may want to schedule a FEES test to get more information
about the cause of your possible dysphagia.
A similar test is the modified barium swallow test (MBS). This uses X-rays to view
your swallowing. One of the advantages of the FEES test over the MBS is that the FEES
test doesn't use radiation. And unlike the MBS, a FEES test may be done in an office
or clinic instead of a hospital. You may also have a videofluoroscopic swallowing
study or an esophagogastroduodenoscopy (EGD) to assess your throat and how you swallow.
What are the risks of fiberoptic endoscopic evaluation of swallowing?
All procedures have some risks. The risks of FEES include:
The SLP will work to minimize these risks. Your own risks may vary according to your
age, your general health, and the reason for your procedure. Talk with the SLP to
find out what risks may apply to you.
How do I get ready for a fiberoptic endoscopic evaluation of swallowing?
Until your FEES test, your doctor may want to put you on a special diet to help prevent
aspiration. Only eat and drink what is on the approved list. The doctor will instruct
you if there is anything else you need to do to prepare.
Tell the medical team about all medicines you take. This includes any medicine that
thins the blood. You may need to stop taking some medicines before the procedure.
Also tell the medical team if you have had any surgery to your neck, throat, or nose.
What happens during a fiberoptic endoscopic evaluation of swallowing?
If you are a patient in the hospital, the FEES test may be done in your hospital room.
Or, you may go to an ENT doctor’s office or clinic to have the test. Your SLP may
do the procedure alone, or with the help of an ENT doctor or nurse.
Your ENT doctor and/or SLP can give you an idea of what to expect during your test.
The procedure often takes around 20 minutes. Each person’s experience may vary. In
general this is what you can expect:
During the test, you’ll be seated and awake. An anesthetic will be sprayed in your
nose and throat. This is so you don’t feel the -laryngoscope, sometimes called an
Your ENT doctor or SLP quickly inserts the endoscope through your nose and down into
your throat (pharynx). You might feel mild discomfort during the procedure. Some people
also experience a sense of tightness or a gagging sensation. The anesthetic can minimize
The ENT doctor or SLP uses the video screen to see how well you are swallowing and
if you are aspirating. Your ENT doctor or SLP will look at a number of factors. These
include how well secretions are swallowed, how well breathing and swallowing occur
together, and how well the airway closes off. They will also be able to see if there
are any abnormal structural problems.
The laryngoscope may puff small amounts of air into your throat, testing your sensations.
You may also take small amounts of food or liquid. These will be dyed so they can
be seen on the screen.
At the end of the procedure, the laryngoscope will be pulled out from your pharynx
What happens after a fiberoptic endoscopic evaluation of swallowing?
In many cases, you will be told the results of your test right away. You might even
watch a video of the test. If you had the test done in an ENT doctor’s office or clinic,
you will likely be able to drive yourself home after your exam. You will probably
be able to resume your normal activities right away.
If your FEES test shows that you have problems swallowing, the ENT doctor and SLP
will work together to develop a treatment plan for you. This may include modifying
the types of foods you eat. For example, you may need to avoid liquids of a certain
thickness. You may need to make changes in your positioning while you eat. And you
may need to learn certain methods for swallowing better.
It’s important to work closely with your medical team. Carefully following their instructions
can help you reduce your risk of complications, such as pneumonia from aspiration.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure