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Is FEES a reliable test to detect aspiration?
Although FEES is new to the area, endoscopic swallowing assessments have been done for over 20 years. Multiple studies have shown that FEES is as effective as the MBS for detecting aspiration.

Why choose FEES over MBS?
The FEES exam is significantly less expensive than the MBS and as accurate for detecting aspiration and determining oral diet safety. The patient can be tested in any position- bed or chair. There is no radiation exposure or barium flavor in test materials. Patient specific food preferences, pills, and carbonated beverages can be assessed.

Is it painful?
There may be some slight discomfort as the scope is passed through the nose. Once the scope is in place most patients show no sign of discomfort. Studies show that most patients would be willing to repeat the procedure.

Is a speech therapist qualified to administer the test?
With special privileging and training as outlined by the American Speech –Language Hearing Association, FEES is within a speech pathologist’s scope of practice.

What are the contraindications for a FEES exam?
Facial or maxillary fractures
History of nasal trauma, surgery, or severe nose bleeds
Bilateral nasal obstruction
Vasovagal episodes or fainting

How can aspiration be diagnosed when you cannot see the airway during the swallow?
Aspiration can be viewed before and after the swallow directly. It is true that there is a second during the swallow known as “white-out” when aspiration cannot be viewed. However, evidence of aspiration during the swallow is indicated by material viewed below the true vocal cords immediately following the swallow or “white out.” It is also important to note that the entire study is recorded and unlike the MBS, where the fluoro is turned on and off during the exam, the endoscope is always “on” so all management of pharyngeal residues and secretions can be observed and reviewed. This information guides treatment specifically and maximizes outcomes.

What about reflux related information?
Retro-flow of material (from the esophagus to the pharynx) can be viewed during the FEES exam. Swelling and redness of the laryngeal structures may indicate a reflux issue. However, the esophagus cannot be viewed. If the primary concern is esophageal dysphagia, a barium swallow, modified barium swallow or GI work-up should be considered prior to the FEES exam.