Functional Endoscopic Evaluation of Swallowing (FEES)

A FEES exam allows assessment of a child’s upper airway, vocal cord movement, and swallow as it is occurring. During a FEES, an ENT or speech-language pathologist uses a flexible scope to examine the upper airway above the vocal cords, including the nose, back of the throat (pharynx), and upper parts of the larynx and esophagus. The provider also uses the scope to watch the child eat, drink, and vocalize.

The procedure may start by spraying a numbing medicine inside the child’s nose to decrease discomfort during the test. The scope is then gently inserted into a nostril, through the nose, and into an optimal viewing position. The child is given different liquids and foods to swallow, while the provider watches on a screen. Similar to an MBSS, a FEES test may show penetration or aspiration.

FEES Test

Location: Clinic office, hospital room

Advantages

  • No radiation, anesthesia, or sedation

  • Allows a partial view of the pharynx/larynx during the swallowing process. 

  • Allows for the assessment of vocal cord movement.

Disadvantages: 

  • Cannot see past the vocal cords, so cannot diagnose a laryngeal cleft or other lower airway issues. 

  • Only a few cycles of swallows are watched, so intermittent aspiration may not be seen. 

  • The patient is awake and may experience discomfort.

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Swallow Study (MBSS)

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Rigid Scope (DLB)