Does my client really need FEES?

When assessing swallowing, clinical bedside evaluations provide valuable clues, but they cannot reveal the true signs of swallowing difficulties. To understand what’s happening during a swallowing, Flexible Endoscopic Evaluation of Swallowing (FEES) is one of the most useful and accessible tools we have.

FEES allows clinicians to directly view the anatomy and signs of swallowing difficulties in real time. By placing a thin flexible endoscope transnasally, we gain clear visibility of:

• laryngeal function and airway protection
• pharyngeal residue patterns
• penetration and aspiration events (amount, frequency and the client response)
• the impact of secretions, fatigue, and positioning
• how strategies or manoeuvres work –right in the moment

This level of detail simply cannot be seen at the bedside.

One of the greatest strengths of FEES is its flexibility. It can be completed:

• at the bedside
• in ICU
• in aged care
• in outpatient clinics
• in home settings

Because FEES does not require radiation, it can be repeated frequently to track changes, trial interventions, or assess readiness for diet upgrades. Its portability makes it ideal for clients who are medically fragile or unable to travel for a videofluoroscopy.

FEES doesn’t just confirm that a problem exists—it shows why it’s happening. This leads to highly targeted, evidence‑based intervention. FEES helps clinicians directly observe:

• swallowing biomechanics
• airway protection deficits
• the effectiveness of compensatory strategies (e.g., chin tuck, supraglottic swallow)
• the impact of different consistencies and volumes

Therapy becomes more focused, efficient, and personalised.

FEES is critical when clinical decisions involve risk. For clients where aspiration is a concern, FEES provides the objective information needed to make safe, confident recommendations that impact on clients’ quality of life. Imagine having to eat and drink modified consistencies and thickened fluids if they are not really indicated. FEES can give you these answers.

It is especially valuable when supporting decisions such as:

• determining appropriate diet textures
• evaluating candidacy for Eating and Drinking with Acknowledged Risk (EDAR)
• monitoring patients with progressive, fluctuating, or fatigue‑related conditions
• assessing readiness to return to oral intake

Seeing their own swallow on video helps clients and families understand what is happening and why recommendations are being made. This supports shared decision-making, builds trust, and improves adherence to swallowing strategies.

FEES is a cornerstone of contemporary dysphagia assessment. It offers unmatched clarity on pharyngeal and laryngeal function, making it one of the most clinically powerful tools for speech pathologists across acute, rehab, community, and aged care settings.