Frequently Asked Questions


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How does FEES work?

During the procedure, a flexible endoscope is introduced transnasally to the patient's hypopharynx where the SLP can clearly view laryngeal and pharyngeal structures. 

The patient is then led through various tasks to evaluate the sensory and motor status of the pharyngeal and laryngeal mechanism.  Food and liquid boluses are then given to the patient so that the integrity of the pharyngeal swallow can be determined.


Videofluoroscopy (MBSS) has long been viewed as the "gold standard" for evaluation of a swallowing disorder for the comprehensive information it provides.  However, it is not very efficient and accessible in certain clinical and practical situations.  Flexible endoscopic evaluation of swallowing (FEES) has been shown to be safe and effective for assisting in swallowing evaluation, and in therapy as a visual display to help patients learn various swallowing maneuvers. Multiple research articles have also repeatedly proven that FEES is just as accurate and with even better sensitivity and specificity than MBSS.

What are benefits of fees?

  • Higher sensitivity to pharyngeal residue vs. MBSS
  • No radiation exposure
  • No need to transport medically complex patients to radiology
  • FEES are easily performed on bariatric patients and medically fragile patients
  • FEES can be performed at bedside in a wide variety of positions
  • FEES can be utilized on patients on mechanical ventilation
  • A physician does not have to be present during FEES
  • FEES are recorded and displayed in color
  • Direct visualization of laryngeal and pharyngeal anatomy allows for observation of clinically significant findings.
  • No ingestion of barium. Only normal food is given during FEES

What if i need to see the "oral phase"?

The mobile FEES exam is considered an assessment of the “oropharyngeal swallow”, meaning the oral phase can be deduced from the presentation of the bolus to premature spillage in the valleculae. Viewing the oral phase is not going to change whether the patient is aspirating or not, nor does it tell us the amount of spillage and pharyngeal residue, all factors that can be seen in a live, real time, high definition video of the swallow. What is your reasoning for needing to VIEW the oral phase? You can observe the oral phase by standing right in front of the patient and then as soon as the bolus falls passed the epiglottis or the pharyngeal phase of the swallow is initiated, we are able to view it in real time on the screen. Concerned about residue in the oral cavity? Have the patient open their mouth. Concerned about delayed mastication or oral transit time? Count the amount of time between the presentation of the bolus to the initiation of the pharyngeal swallow.



The American Speech and Hearing Association (ASHA) has approved endoscopy to be utilized by highly specialized and licensed Speech Language Pathologists to assess swallowing function. Furthermore, the state of Texas (similar to 46 other states) does not require a physician to be present or to interpret results of the study. Please see ASHA's Use of Endoscopy by Speech-Language Pathologists: Position Statement for further details


Although FEES can be performed on virtually any person of any age, the following populations benefit greatly from endoscopy:

  •  Ventilator dependent patients
  •  Patients who easily fatigue
  •  Patients unable to leave contact isolation rooms
  •  Suspected aspiration of secretions
  •  Suspected laryngopharyngeal reflux
  •  Patients with known vocal fold paresis or paralysis 
  •  Patients with contractures or decubitus ulcers who cannot maintain upright positioning
  •  Suspected intubation/extubation trauma, including edema or erythema
  •  Patients with chronically wet vocal quality or throat clearing
  •  Dementia or TBI patients who are routinely confused and/or unable to follow commands 

Is fees safe?

  • Of the potential risks associated with endoscopy, including gagging, nose bleed, laryngospasm, and vasovagal response; a mild case of a nose bleed that stops on it own is the most prevalent.
  • The rate of complications associated with FEES is less than 1% overall.
  • FEES has proven to be a safe and well tolerated method of assessing swallow function when performed by a trained Speech Language Pathologist.

What if you can't see aspiration during the "white out" phase?

Did you know that only 5% of aspiration occurs DURING the swallow? Meaning the other 95% we can see beautifully during the FEES procedure. The reason that green or white food dye is used during the procedure is for this exact reason. If the patient falls in that 5%, we are able to see the dye below the level of the vocal folds.

What if i need to see the "esophageal phase"?

Studies have shown that many signs and symptoms of esophageal dysphagia can actually be viewed better on a FEES than on an MBSS. If esophageal dysfunction is our main concern, the referral should be made to a GI doctor, which the recommendations of the MBSS will state as well.