Endoscopic Evaluation of Swallowing (FEES) is a procedure in which a fiberoptic endoscope is inserted
through the nose and into the throat to obtain a direct visualization of
structures, a dynamic view of the oral–pharyngeal transfer, and indirect
evidence of the pharyngeal–esophageal transfer during swallows.
Saliva swallowing can be evaluated,
and the anatomy and physiology of saliva swallow can be viewed in the absence
of acceptance of food and/or liquids. The swallow is then assessed with
presentation of food and liquid.
Endoscopic Evaluation of Swallowing With Sensory Testing (FEESST), a modification of FEES, is a test
of the Laryngeal Adductor Response (LAR), a reflexive vocal fold adduction in
response to a pressure- and duration-calibrated air puff delivered anterior to
the arytenoids along the aryepiglottic folds. The test measures the intensity
level at which the LAR is elicited.
FEES procedures are indicated when
there is a need for
- visualizing structures and observing a dynamic view of
the oral–pharyngeal transfer with or without presentation of food and/or
- additional instrumental assessment, based on previous
- assessment of the LAR sensitivity and vocal fold
- alternate testing—for example, when the child is not a
good candidates for VFSS because he or she
cannot be positioned
adequately for VFSS or
cannot be transferred
to the radiology suite.
- The appropriate endoscope size is chosen, and a
decision is made about whether the endoscope should be equipped with air
- The endoscope is then passed by the SLP or physician,
and the child is given an opportunity to calm.
- The nasal, oral, pharyngeal, and laryngeal anatomy is
- FEESST is administered, if indicated, to determine LAR
sensitivity and vocal fold dynamics.
- The child eats and/or drinks a variety of preferred and
problem foods under fiberoptic observation.
- Monitoring (e.g., cardiovascular) during FEES
procedures may be warranted for children with significant pulmonary
disease, cardiac arrhythmia, seizure disorders, or other medical
- It is advisable to have suction equipment available and
trained personnel on hand during testing.
- The possible risks for localized nasal trauma and
bleeding are considered.
is taken with use of topical anesthesia in medically fragile infants and
children. Clinicians are encouraged to consult with the child’s medical team
prior to using anesthesia with these children.