Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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Fiberoptic Endoscopic Evaluation of
Swallowing(FEES)

• Jaclyn Weiss

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It Is Also Called

• Videoendoscopy
• Flexible fiberoptic examination of swallowing
• Endoscopy

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What Is It Used For?

• FEES allows for the direct viewing of swallowing
  function when regular food materials are eaten.
• It identifies functional abnormalities that may
  occur and is used in 'practice swallows' to help
  determine the safest position and food texture to
  maximize nutritional status and eliminate the
  risk of aspiration and unsafe swallowing.
• It assess the existence of Dysphagia or
  swallowing disorders.

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How Does It Work?

• A flexible fiberoptic laryngoscope is passed
  through the nasal cavity and placed in the
  pharynx at the level of the soft palate.
• In order to make the patient more comfortable,
  the inside of the nose is coated with a gel to
  reduce the sensation of the endoscope being
  passed.
• Once the patient is comfortable, he or she is
  given foods or liquids that are tinted with food
  dye so the examiner can follow their passage.

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What To Look For

• The examiner then watches the material as it
  passes from the base of the tongue into the
  esophagus (swallowing passageway).
• Careful observation is made of foods and liquids
  that are retained in various areas.
• Deviation of the bolus (food or liquid) from its
  normal path during the swallow is also observed.
  

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Abnormal Findings Include

• Premature Spillage material enters the
  hypopharynx before the laryngeal swallow is
  initiated can pool in the vallecula, pyriform
  sinuses and posterior larynx.
• Residue coating of the walls in the hypopharynx
  that can be penetrated or aspirated.
• Penetration bolus sits on the superior surface
  of the larynx or is above the vocal folds
• Aspiration bolus passes below the true vocal
  folds

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Other Things to Look For

• Laryngeal inflammation
• Vocal fold mobility
• Glottal closure
• Pharyngeal contraction
• Speed of the swallow
• Secretion management
• Fatigue
• Incoordination of breathing and swallowing
• Incoordination of bolus flow and airway protection

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What Structures Can Be Seen?

• The relationship between the epiglottic airway
  entrance, valleculae, aryepiglottic folds, and
  pyriform sinuses can be seen.
• One can also see the movement of the pharyngeal
  wall, true and false vocal fold adduction, the
  anterior and medial movement of the arytenoids
  and laryngeal elevation.

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What Is Not Seen?

• This diagnostic procedure does not visualize the
  oral stage of swallowing.
• There are four stages of swallowing (Oral
  Preparatory, Oral, Pharyngeal and Esophageal
  Stages)
• The oral stage is obscured by the initiation of
  the pharyngeal swallow which causes the
  pharyngeal wall to close around the endoscopic
  tube which blocks the image during the swallow.

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Why Is This A Bad Thing?

• Many important events occur during this stage
  that the clinician must now have to infer from
  the location of the residual food when the
  endoscopic image returns to view
• This is therefore an indirect process based on
  symptoms rather than actual observation of the
  swallow itself.
• This makes it very difficult to define the exact
  nature of the patients physiologic disorder and
  the effectiveness of treatment strategies.

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Advantages To Using FEES

• Excellent superior view of structures
• Can also assess sensory awareness of structures
• Same day exam
• No radiation is involved
• It is mobile
• Can be used for biofeedback for the patient and
  family
• Can be used at bedside for critically ill patients

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Components

• 1. Endoscope
• The flexible insertion shaft of the endoscope is
  approximately 40 cm long and has a diameter of
  3.2 - 4.0 mm.
• The tip of the device is flexible and can move
  upward or downward and angle itself for the best
  image
• The typical endoscope has a 90 field of view

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Components Continued

• 2. Camera
• The endoscope is hooked to a camera
• The results of the evaluation are recorded on
  videotape or CD ROM for later viewing or use for
  patient and family education and instruction.

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Components Continued

• 3. Light
• Either xenon or halogen light sources are
  conducted along a fiberoptic bundle which travels
  the length of the scope
• This provides adequate light to assess swallowing
  function

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How Does The Clinician Know When To Use FEES?

• The patient complains of a weak voice
• The patient chokes after eating or drinking
• The food still feels like it is in the throat
• There is a significant change in the voice after
  swallowing (wet voice)
• The patient complains of pain or discomfort
• Dribbling is observed
• Nasal regurgitation is observed

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Summary

• FEES is a standard test using a small flexible
  fiberoptic endoscope which is a small tube with a
  light on the end of it that is attached to a
  camera.
• It is passed through the nose to obtain a view
  directly down the throat during swallowing. The
  tube does not go down the throat, but provides a
  bright light so the swallow can be observed.

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Summary

• This procedure is painless and well tolerated by
  most individuals.
• The entire test takes about five to six minutes
  once the patient is properly prepared.

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The Endoscope entering the nasal cavity
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The components of the Endoscope
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Superior Endoscopic view of the vocal folds