A picture is worth a thousand words!
At North Louisiana Swallow Solutions, we provide mobile FEES (Flexible Endoscopic Evaluation of Swallowing) services. FEES has been found to be a GOLD STANDARD in assessment and management of oropharyngeal dysphagia. Recent research has shown that FEES and MBSS have a 97-100% inter-rater reliability, but did you know that FEES has been shown to be higher in specificity and severity in identifying penetration, aspiration, residue, and spillage? You do now!
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.
Is it within the slp scope of practice?
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 Louisiana (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.
is fees considered a "gold-standard" assessment?
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.
Although videofluoroscopy (MBSS) has long been viewed as the "gold standard" for evaluation of a swallowing disorder for the comprehensive information it provides, it is not always efficient and accessible in certain clinical and practical situations.
which patients benefit most from fees?
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
when is fees preferred over mbss?
Flexible endoscopic evaluation of swallowing (FEES) is the preferred test over videofluoroscopy in the evaluation of a swallowing disorder in any of the following conditions:
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; or
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); or
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); or
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); or
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); or
When there is a suspicion that laryngeal competence may be compromised in a member with a tracheostomy; or
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).