Test / Diagnostic Procedure: Flexible Endoscopic Evaluation of Swallowing (FEES)

A Flexible Endoscopic Evaluation of Swallowing (FEES) is a procedure used to assess how well you swallow. FEES is an outpatient procedure and is performed by an ear, nose and throat (ENT) specialist jointly with a speech and language/ swallowing therapist (SLT).

The device used in FEES is called a flexible nasendoscope. This is a thin, flexible tube with a small camera and light on the end that is inserted up into the nose to give your specialists a view of your throat as you swallow and breathe.

Swallowing and breathing require a series of actions from the muscles in parts of the throat called the pharynx and larynx. A FEES is done to assess if you have a problem called dysphagia (trouble swallowing).

Dysphagia happens when something is going wrong with the muscles in the throat that control swallowing. It is important to identify dysphagia as it can lead to food or fluid going into the lungs or airways (aspiration) which can cause serious health problems including pneumonia. If there is a weakness in the swallowing muscles, this can lead to food getting stuck in the throat.

You should talk to an ENT specialist about FEES if:

• It feels like food gets stuck in your throat when swallowing
• You cough when you eat or drink
• Swallowing is painful
• You have a medical condition that increases your risk of dysphagia such as a neurological condition (for example, Parkinson’s disease, multiple sclerosis), a respiratory condition (such as Chronic Obstructive Pulmonary Disease (COPD)) or have had a diagnosis of cancer, particularly head and neck cancer

At OneWelbeck, you will have a consultation with the ENT consultant and/ or your SLT before the procedure. They will take you through what is involved and answer any questions you may have. They will also ask you to disclose any medications you’re currently taking, as well as any medical conditions you have.

Your specialist will tell you at your consultation if there is anything else you need to do to prepare.

At OneWelbeck, FEES is performed as an outpatient procedure and will only take around 20 minutes. You’ll be seated and awake throughout the procedure and shouldn’t feel any pain.

Your consultant will insert the endoscope into your nose and down into your throat. This may be uncomfortable at the start and you may feel a sense of tightness in your throat or the need to gag. Gentle slow breathing with the guidance of your consultant will allow you to get used to the scope.

Looking on a video screen, your ENT consultant and the SLT will carry out an assessment to see how your throat muscles and voice box are working.

You will then be asked to drink and eat different types of food. You will be assessed to see how safe your swallowing is and how strong and coordinated your swallowing muscles are. The SLT may suggest ways to improve your swallowing during the examination.

At the end of the procedure, the endoscope will be gently removed out from your throat and nose.

Your ENT and SLT consultants will talk you through what they found straight away. You will then receive a report with recommendations and if required, a treatment plan. This may involve avoiding certain foods or liquids, or holding your head in certain positions could help you swallow more safely. You may also be given exercises to improve your swallowing.

As FEES is an outpatient procedure, you will be able to go home as soon as it’s been done and can resume normal activities straight away.

There is very little risk associated with FEES and complications are very rare when the procedure is performed by an experienced consultant.

The risks vary based on your age, general health and your reason for having FEES. Your consultant will be able to talk you through any potential risks that could affect you.