Considerations for FEES

Both fiberoptic endoscopy and videofluoroscopy are medically necessary for evaluation of swallowing function.

Patients may need a FEES if they are experiencing the following symptoms:

  • Choking when eating.

  • Coughing, throat clearing, or gagging when swallowing.

  • Drooling.

  • Feeling like food or liquid is coming "back up" into the throat.

  • Hoarseness.

  • Sensation of food "getting stuck" in the throat

  • Unexplained weight loss.

  • Difficulty controlling food in the mouth.

  • Difficulty starting the swallowing process.

  • Difficulty swallowing pills.

  • Recurrent pneumonia.

  • Difficulty managing saliva/secretions in the mouth or throat.

  • Avoiding certain foods/drinks

  • Taking an extended time to finish a meal.

  • Pain with swallowing.

Patients may experience swallowing difficulty after surgery, a stroke, head/neck cancer, head injury, Parkinson's disease, dementia, COPD, and various other conditions.

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Considerations for speech language pathologists


Fiberoptic endoscopic evaluation of swallowing (FEES) is the preferred test over videofluoroscopy in the evaluation of a swallowing disorder in any of the following conditions but not limited to:




-A more conservative examination than videofluoroscopy is required because of concerns about aspiration of barium, food, and/or liquid; or

-Need to assess fatigue or swallowing status over a meal; or

Repeat examination to assess change; to assess effectiveness or need for maneuvers;

-Severe dysphagia with very weak or possibly absent swallow reflex and/or very limited ability to tolerate any aspiration (e.g., brainstem stroke, member tube-fed for prolonged period, very poor pulmonary status, or, poor immunologic status);

-Therapeutic examination that requires time to try out several maneuvers, several consistencies, etc. (e.g., want to try real foods; want parent to hold baby in several positions; or want to try biofeedback);

-To visualize the larynx directly for signs of trauma or neurological damage and assess laryngeal competence post-intubation or post-surgery (especially with coronary artery bypass grafting, carotid endarterectomy, or any surgery where the recurrent laryngeal nerve was vulnerable);

-When positioning for fluoroscopy is problematic (e.g., member bedridden, weak, has contractures, in pain, has decubitus ulcers, quadriplegic, wearing neck halo, obese, or, on ventilator);

-When there is a suspicion that laryngeal competence may be compromised in a member with a tracheostomy;

-When transportation to fluoroscopy is problematic (e.g., medically fragile/unstable member in an intensive care unit, cardiac or other monitoring in place, on ventilator, or, nursing/medical care must be with member);

-When transportation to the hospital is problematic (e.g., nursing home issues, including cost of transportation, resources needed to accompany member, strain on member, or, member fearful of leaving familiar surroundings, etc.).