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Speech and Hearing Center

Swallow Studies – FEES

Swallowing Evaluations and FEES

Helping You Eat and Drink More Safely

Difficulty swallowing can affect nutrition, hydration, health, independence, and quality of life.

The Marshall University Speech and Hearing Center provides comprehensive swallowing evaluations, including Flexible Endoscopic Evaluation of Swallowing (FEES), for adults experiencing difficulty eating or drinking safely and efficiently.

FEES allows our clinicians to directly observe swallowing using a small flexible camera. The information gathered during the evaluation helps identify the cause and severity of swallowing difficulties and guides individualized recommendations for diet, safety, and treatment.

What Is Dysphagia?

The medical term for difficulty swallowing is dysphagia.

Dysphagia can affect one or more stages of swallowing and may involve difficulty moving food or liquid through the mouth, throat, or esophagus.

Swallowing difficulties can occur as a result of:

  • Stroke
  • Parkinson’s disease
  • Amyotrophic lateral sclerosis (ALS)
  • Multiple sclerosis
  • Traumatic brain injury
  • Dementia or other neurological conditions
  • Head and neck cancer
  • Radiation or surgical treatment
  • Neuromuscular disorders
  • General medical illness or deconditioning
  • Other conditions affecting swallowing function

Some swallowing problems are obvious, while others may be more subtle. An instrumental swallowing evaluation can help determine what is happening during the swallow and whether treatment or diet modifications are needed.

 

Signs You May Benefit from a Swallowing Evaluation

Consider discussing a swallowing evaluation with your healthcare provider if you experience:

  • Coughing or choking while eating or drinking
  • A wet or “gurgly” voice after swallowing
  • Food or liquid feeling stuck in the throat
  • Difficulty chewing or moving food through the mouth
  • Frequent throat clearing during meals
  • Difficulty swallowing pills
  • Meals taking significantly longer than they used to
  • Unexplained weight loss
  • Dehydration
  • Recurrent pneumonia or respiratory infections
  • Increased shortness of breath during meals
  • Avoiding certain foods because they are difficult to swallow
  • Needing to modify food textures or liquid consistencies
  • A new swallowing difficulty following illness, surgery, stroke, or neurological diagnosis

If swallowing difficulties are affecting your ability to eat, drink, or take medications safely, an evaluation can help identify appropriate next steps.

 

What Is FEES?

Flexible Endoscopic Evaluation of Swallowing, or FEES, is an instrumental swallowing assessment performed by a specially trained speech-language pathologist.

During the examination, a small flexible scope with a camera is gently passed through the nose and positioned above the throat. You then eat and drink selected foods and liquids while the clinician observes your swallowing.

FEES allows the clinician to evaluate:

  • Structures of the throat and larynx
  • Management of saliva and secretions
  • Movement of food and liquid through the throat
  • Swallowing safety
  • Penetration or aspiration
  • Residue remaining after the swallow
  • Effectiveness of different swallowing strategies
  • Changes in swallowing across repeated trials
  • Which food and liquid consistencies may be safest or most efficient

The results help guide recommendations for diet, swallowing strategies, and treatment.

 

What to Expect During a FEES Evaluation

Before the procedure begins, your clinician will review your medical history, current swallowing concerns, medications, diet, and any previous swallowing evaluations.

During the procedure:

  • A small flexible scope is passed through one side of the nose
  • The scope remains above the vocal folds and does not enter the airway
  • You will be asked to eat and drink different foods and liquids
  • Your clinician will observe how safely and efficiently you swallow
  • Different strategies or positions may be tried to determine whether they improve swallowing

The procedure does not require radiation, so swallowing can be observed repeatedly as needed.

After the examination, your clinician will review the findings with you and discuss recommendations.

 

What Can We Learn From FEES?

A FEES evaluation can provide detailed information about swallowing function and help answer questions such as:

  • Is food or liquid entering the airway?
  • Is material remaining in the throat after swallowing?
  • Are certain food textures or liquid consistencies easier or safer to swallow?
  • Does changing head position improve swallowing?
  • Do swallowing strategies reduce aspiration or residue?
  • Is fatigue affecting swallowing during a meal?
  • Is the person managing saliva and secretions effectively?
  • Would swallowing therapy be beneficial?

Recommendations are individualized based on both the examination findings and the person’s medical condition, preferences, and everyday needs.

 

FEES vs. Modified Barium Swallow Study

Both FEES and the Modified Barium Swallow Study (MBSS) are instrumental examinations used to evaluate swallowing.

FEES

FEES:

  • Uses a small flexible camera passed through the nose
  • Does not use radiation
  • Allows direct visualization of the throat and larynx
  • Allows extended or repeated trials when clinically appropriate
  • Can be particularly useful for evaluating secretions and fatigue
  • Can be completed in the clinic and, in some circumstances, at other care facilities

Modified Barium Swallow Study

An MBSS:

  • Is completed using X-ray
  • Requires swallowing foods and liquids mixed with barium
  • Allows visualization of the mouth, throat, and upper portion of the esophagus during swallowing
  • Provides a different view of swallowing physiology than FEES

Neither test is universally “better.” The appropriate examination depends on the individual’s symptoms, medical history, and the clinical questions that need to be answered.

Most people do not require both tests, although there are situations in which information from both examinations may be useful.

The Marshall Speech and Hearing Center does not offer Modified Barium Swallow Studies as this test is completed at the local hospital with an xray machine.

 

What Happens After the Evaluation?

After your FEES evaluation, your speech-language pathologist will discuss the findings and recommendations with you.

Recommendations may include:

  • Continuing your current diet
  • Modifying food texture or liquid consistency
  • Changing positioning during meals
  • Using individualized swallowing strategies
  • Changing the size or pacing of bites and sips
  • Beginning swallowing therapy
  • Completing specific swallowing exercises
  • Referral to another healthcare provider
  • Additional medical evaluation
  • Follow-up swallowing assessment

Whenever possible, our goal is to identify recommendations that promote both swallowing safety and quality of life.

 

Swallowing Therapy

If treatment is recommended, swallowing therapy is individualized based on the specific physiologic impairments identified during the evaluation.

Therapy may focus on:

  • Improving tongue strength or coordination
  • Improving tongue-base retraction
  • Increasing pharyngeal strength
  • Improving airway protection
  • Improving coordination of breathing and swallowing
  • Strengthening muscles involved in swallowing
  • Practicing compensatory swallowing strategies
  • Improving efficiency during meals

Treatment recommendations are based on evaluation findings rather than using the same set of exercises for every patient.

FEES Services for Skilled Nursing Facilities

The Marshall University Speech and Hearing Center can also provide FEES services for individuals residing in participating skilled nursing facilities.

Providing instrumental swallowing assessment within the facility may allow residents to receive a comprehensive evaluation without the burden of traveling to an outpatient hospital or clinic.

Skilled nursing facilities interested in arranging FEES services may contact the Marshall University Speech and Hearing Center for availability and pricing information.

 

Insurance and Payment

When FEES is completed at the Marshall University Speech and Hearing Center, we bill insurance for the swallowing evaluation.

Coverage and individual out-of-pocket costs vary by insurance plan. Patients are encouraged to contact their insurance provider regarding deductibles, copayments, and coverage for instrumental swallowing evaluations.

Pricing for FEES services provided at skilled nursing facilities may differ. Facilities may contact our office for additional information.

 

Schedule a Swallowing Evaluation

If eating or drinking has become difficult, uncomfortable, or concerning, a comprehensive swallowing evaluation can help determine what is happening and identify appropriate next steps.

Contact the Marshall University Speech and Hearing Center at 304-696-3641 to learn more about FEES, physician referral requirements, insurance billing, or scheduling a swallowing evaluation.