YOON

Speech and Swallowing

Instrumental Swallow Evaluation (FEES)

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) lets us see directly how the throat works during eating and drinking. A thin, flexible endoscope is passed through the nose by an ENT doctor, giving a clear view of the throat while the patient swallows small amounts of food and fluid. Our speech therapist works alongside the ENT doctor to plan and carry out the swallowing tests, interpret the findings, and recommend safe food and drink textures and therapy. FEES can be carried out at an ENT doctor’s clinic or, where suitable, at the patient’s home.

Illustration of a FEES swallow examination, with a flexible endoscope passed through the nose and the throat shown on a monitor
Illustrative image: a FEES examination gives a clear camera view of the throat and voice box.

The examination can show food or liquid spilling into the throat too early, residue left behind after swallowing, and aspiration, which is food or liquid entering the airway. This gives doctors, therapists and families clear, objective information to guide safer food and drink textures and the next steps in treatment.

What we see during FEES

The endoscope gives a clear, close-up view of the throat and voice box. These images are from our own FEES examinations, with identifying details removed.

Labelled FEES endoscopic view of the larynx showing the epiglottis, vocal cords, arytenoids, pyriform sinuses, valleculae and base of tongue
The view during FEES: the main structures of the throat and voice box
FEES view of white foamy secretions pooling in the pyriform sinuses
Foamy secretions pooling in the pyriform sinuses
FEES view of the back wall of the throat pushed forward by anterior cervical osteophytes
Anterior cervical osteophytes (bony spurs on the neck spine) narrowing the throat
FEES view of blue-dyed food filling the throat in a rising tide pattern
“Rising tide”: blue-dyed food filling the throat before the swallow is triggered

FEES or videofluoroscopy?

Videofluoroscopy (VFS), also called a modified barium swallow, is a moving X-ray of swallowing carried out in a hospital. Both tests let us look closely at how the swallow works. We can advise which is more suitable for each patient.