Flexible Endoscopic Evaluation of Swallowing (FEES)

FEES is Fibreoptic/Flexible Endoscopic Evaluation of Swallowing. It involves the insertion of a flexible, thin tube into the nose. This is called a nasendoscope. It allows visualisation of the throat during swallowing. There is a light and camera attached to the nasendoscope to enable optimal viewing and recording of the assessment. A copy of the videorecording can be provided at no extra cost.

The assessment comprises three parts. The first part involves the assessment of symmetry and movement of swallowing structures (e.g., the walls of the throat, the vocal cords, and the soft palate), without eating or drinking. The second part involves assessment of swallowing using a range of food and fluids which are usually dyed with food dye to enable easier visualisation. The third section involves trying swallowing techniques and positions to overcome any swallowing difficulties. All three sections are required for a comprehensive swallowing assessment.

FEES is not painful, although there is some discomfort when the tube is initially inserted into the nose. However once in place, this discomfort subsides.

Findings from FEES include:

• Identification of structural and biomechanical impairments contributing to dysphagia.
• Identification of foods, fluids, or saliva “going the wrong way”. This is called aspiration and can lead to aspiration-related pneumonia.
• Identification of foods, fluids, or saliva that get stuck in the throat and where it gets stuck.
• Identification of foods, fluids, or saliva that are mis-directed into the nose
• Identification of strategies, techniques, and positions to improve swallowing (i.e., reduce aspiration and improve clearance of food and fluids from the throat into the oesophagus).
• Identification of foods and fluids that are problematic and that should be avoided.