fiberoptic endoscopic evaluation of swallowing (FEES)
/ FEES, rhymes with 'fees' /
Sometimes the swallow you most need to watch belongs to a person who cannot easily be wheeled to a radiology suite — a frail patient in the intensive care unit, someone in a nursing home, or anyone who should not be given more radiation. FEES answers that need by bringing the camera to the patient: a very thin, flexible scope is passed through the nose and parked in the throat, giving a direct, live, close-up view of the swallowing machinery from above.
During FEES a speech-language pathologist (or physician) numbs the nostril, slides the endoscope down until the tip sits above the voice box, and then has the person eat and drink foods coloured with dye so they stand out. Through the camera the clinician sees the throat directly: whether food pools in the side pockets, whether the airway closes, and whether coloured material spills into the airway entrance — aspiration caught on camera. There is a brief 'white-out' moment when the throat squeezes shut at the height of the swallow, so the exact instant of the swallow is hidden, but everything just before and just after is shown in full colour. It also lets the clinician check the patient's own ability to sense and clear material, and to manage secretions.
FEES and the videofluoroscopic study are complementary, not rivals. FEES uses no radiation, can be done at the bedside, can run longer to test a realistic meal or a fatiguing patient, and shows secretions and tissue colour beautifully; but it cannot see the oral phase, has that brief white-out at the key moment, and involves passing a scope. Many programmes use whichever fits the patient, or both. The honest point is that either instrumental study sees far more than bedside observation, especially for the silent aspirator who never coughs.
A patient on a ventilator in the ICU is too unstable to travel to radiology. The speech therapist brings a FEES cart to the bedside, passes the scope, and watches him swallow dyed applesauce: secretions are pooling and some green-dyed puree drifts toward the airway. The bedside study gives an answer that watching him eat could never have provided.
FEES brings a radiation-free, bedside camera to swallowing — complementary to the X-ray study.
FEES is not 'better' or 'worse' than the videofluoroscopic study — they show different things. FEES misses the oral phase and the exact swallow moment (white-out); the X-ray study misses secretions and tissue colour and adds radiation.