The right tool for the right job. Access to objective instrumental data allows for better management of dysphagia. Learn more about FEES below or Contact Us with your questions!

What is FEES?

What is FEES?
Flexible Endoscopic Evaluation of Swallowing, or FEES, is an instrumental exam designed to assess a patient’s swallow.  Using a small, flexible endoscope containing a light and camera, a specially skilled SLP passes the scope transnasally along the floor of the nose until the pharynx and larynx are in view.   As the patient performs various tasks and consumes a variety of solids and liquids, the SLP evaluates anatomy/physiology of the pharynx and larynx including sensation, presence of aspiration, effectiveness of compensatory strategies, secretions, and tissue integrity. These areas can NOT be fully assess during a bedside swallowing exam.



ASHA scope of practice specifically states SLPs have an inability to fully assess pharyngeal phase of swallowing at bedside and must use an instrumental in order to fully assess the pharyngeal phase.

This idea extends to the actions of changing diets at bedside without an instrumental – if you don’t know what’s wrong, how can you be sure you’re fixing “it” and not doing more harm to the patient?

We would balk at the idea of a physical therapist treating a hip fracture or a physician treating a stroke without first confirming diagnosis with the aid of imaging diagnostics and using that information to form an appropriate treatment plan.  Equally, SLPs should have access to objective imaging diagnostic information in order to identify dysphagia and treat effectively.

Cost of dysphagia

Cost of Dysphagia

Patients frequently cite dislike as the reason for limiting/avoiding intake of thickened liquids and pureed foods. These patients have higher rates of dehydration and urinary tract infections – two of the top five reasons for unplanned rehospitalizations. 

Rehospitalization costs for pneumonia not requiring use of the ICU is a minimum of $14,400 per episode. Then add in the cost of thickener per year: $2088-$3468 per patient and enteral feeds: $31,832 ($46,257 adjusted for inflation) per patient. (O’Keeffe 2018, Callahan et. al 2001, respectively. See Research Resources).

Multiply by the number of affected residents in the facility and the numbers begin to skyrocket.  Having access to FEES can help to minimize these costs and help to lower readmission rates.

Reducing readmissions

Reducing Readmissions – Physicians

With rehospitalization for an uncomplicated course of pneumonia costing over $14,400 per episode and care costs for a PEG averaging $46,257 (adjusted for inflation) per year, it’s in the best interest and health of the patient and the facility to minimize these occurrences as much as possible.  Let SuperiorView Swallowing Diagnostics help you lower these risks. 

By incorporating FEES into the ongoing dysphagia management plan, the SLP and physician is equipped with valuable information regarding the swallow function that can NOT be gained from a bedside exam.  Results are immediate, preventing delays in care decisions.  

With this objective information, we assist the SLP in developing an effective treatment plan which includes minimizing pneumonia risk and need for more invasive procedures (e.g. feeding tubes).  


FEES vs VFSS Comparison

Both exams are valid and specific assessments to assess dysphagia in a patient with research showing FEES (Flexible Endoscopic Evaluation of Swallowing) to be as sensitive and specific as VFSS (Videofluoroscopic Swallow Study). However, there are certain parameters where a FEES may provide more valuable information than a VFSS.

Accommodate positioning restrictions including halos/braces, head of bed restrictions/spinal cord injuries, and contractures, which may otherwise limit the view capabilities in the radiology suite.

No limitations on length of exam; easily assess patient endurance during a meal.

Assess patient specific food preferences, pills, and carbonated beverages.

Directly view the larynx and pharynx including vocal fold appearance and movement, tissue integrity including signs of reflux, and secretion management.

Portability to perform exam in the patient’s environment – intensive/specialty care type units/vents, medical floor, inpatient rehab, skilled nursing. No fatiguing transportation for medically fragile/cognitively impaired patients. Outpatient services are also available.

Record entire exam (unlike VFSS where the fluoro is turned on and off during the exam). The endoscope is always “on” to view management of pharyngeal residues and secretions.

Less expensive than the VFSS.

Safety and reliability of FEES

Safety and Reliability of FEES

Research has repeatedly proven FEES to be a safe, reliable, and well tolerated exam to assess dysphagia.

With a < 1% complications rate, potential risks including gagging, epistaxis, laryngospams and vasovagal response are quite infrequent  Per the research, when complications do occur, severity is mild.

Check out the Research Resources page for specific articles on FEES safety.

Patient comfort and anesthesia

Patient Comfort and Anesthesia

With a trained, experienced SLP passing the endoscope, discomfort is minimized as the endoscope is passed transnasally. Majority of patients typically describe the sensation asweird” or “odd” rather than one of pain.

Once the scope is in place, most patients show no sign of discomfort.  Research indicates patients are willing to repeat the procedure.

SuperiorView Swallow Diagnostics utilizes 3.6mm nasopharyngoscopes for comfort and are smaller than the diameter of your index finger. 

Multiple studies have shown no significant difference in swallowing performance between non-anesthetized patients and those anesthetized with lidocaine.  High levels of topical anesthesia has been shown to negatively affect swallow performance.

See the Research Resources page for study specific articles.