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Fiberoptic Endoscopic Evaluation of Swallowing

When difficulty swallowing (dysphagia) is suspected, an objective instrumental assessment is necessary.

An instrumental assessment determines the specific structures that are impaired, the severity of the deficits, the diet/liquid textures that are safest, and the specific exercise program that can target the affected musculature to improve swallowing abilities.


SPS of WNY is proud to offer state-of-the-art fiberoptic endoscopic evaluation of swallowing (FEES) procedures to patients at the Lockport office or those in skilled nursing/ home health settings via mobile FEES on a case by case basis. SPS of WNY’s owner and endoscopist, Caroline Lewandowski, is one of only a handful of adult focused speech-language pathologists to provide the latest evidence-based dysphagia services to Western New York and surrounding areas.

About the Procedure 

During a FEES assessment, a small flexible scope with a high resolution digital camera on the end is passed through the nose into the throat to achieve a clear view of the swallowing musculature. This allows a bird’s eye view of the pharyngeal and laryngeal structures and the airway during swallowing to assess for any aspiration. Aspiration is when food or liquid enters the trachea and passes into the lungs instead of the esophagus and into the stomach. While the scope is in place, the speech pathologist will present you with various foods and liquids mixed with a drop of green food coloring so they can be differentiated from saliva/secretions.

Currently the two gold standards for evaluating swallowing are fiberoptic endoscopic evaluation of swallowing (FEES) procedures and modified barium swallow studies (MBSS). Both procedures have advantages for certain diagnoses. A modified barium swallow study is a video x-ray where radiation is applied during the swallow and viewed from the side. Since there is no radiation exposure with FEES, the scope can be left in place longer (e.g., to assess for fatigue throughout a meal) versus only observing a couple bites/drinks. The camera video footage is left on continuously and recording the entire time the scope is in place. Having continuous footage throughout the study provides beneficial diagnostic information since aspiration is most common after the swallow on residue or reflux. Patients can bring in their own food if there is a particular item that is causing difficulty, including pills.

FEES also allows for high-resolution full color images of the anatomy itself rather than an x-ray view containing only an outline of structures. If any anatomical concerns are noted (e.g., a mass, redness or inflammation, etc.), SPS of WNY will refer you to the appropriate medical specialist to further assess (e.g., ENT or GI). A FEES exam also allows direct visualization of vocal fold movement and saliva management, both very important factors in aspiration pneumonia risk which cannot be observed via x-ray.

SPS of WNY will provide you with a full detailed report of the study, including images of relevant findings. SPS of WNY will maintain close communication with your physician when completing swallow studies and make recommendations to reduce aspiration risk. Our goal is to determine the best course of treatment for rehabilitating the swallow, making referrals to other specialists when necessary. 

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