What Is FEES?

FEES is an acronym for Flexible Endoscopic Evaluation of Swallowing. This evaluation is completed by a privileged Speech-Language Pathologist using a flexible endoscope which is passed transnasally to allow viewing of the pharyngeal and laryngeal structures, assessing motor and sensory function as the patient completes a series of tasks. The swallowing process is observed and evaluated as the patient is given various food and liquid textures during the exam.

The following is an excerpt from the ASHA document, The Role of the Speech-Language Pathologist in the Performance and Interpretation of Endoscopic Evaluation of Swallowing: Technical Report developed by ASHA Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Endoscopic Evaluation of Swallowing:

“FEES is a comprehensive assessment of swallowing. It includes five components:

  • Observation of the anatomy involved in the oropharyngeal stage of swallowing,
  • Observation of the movement and sensation of critical structures within the hypopharynx,
  • Observation of secretions,
  • Direct assessment of swallowing function for food and liquid, and
  • Response to therapeutic maneuvers and interventions to improve the swallow.

The purpose of the procedure is the comprehensive functional evaluation of the oropharyngeal stage of swallowing, leading to recommendations regarding the adequacy of the swallow, the advisability of oral feeding, and the use of appropriate interventions to facilitate safe and efficient swallowing.

ASHA affirms the role of the speech-language pathologist in performing FEES independently to evaluate swallowing function, and distinguishes it from that of physicians, who use endoscopy to assess the integrity of the laryngeal and pharyngeal structures in order to render a medical diagnosis.”


Aspiration of Thin Liquids

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Decreased VF Adduction


Medications in Vallecula

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Penetration Through the Interarytenoid Space


Pharyngeal Residue

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Secretions Observed Upon Endoscope Insertion

Benefits of FEES over MBS

FEES offers a direct full-colored view of the anatomical structures and is beneficial to assess for s/s oral, pharyngeal or esophageal dysphagia including Laryngopharyngeal reflux (LPR), and Vocal Fold function.

FEES also benefits a patient who has had a MBSS with inconclusive results, or when they need another advanced instrumentation diagnostic study.

A FEES service is significantly more cost effective than an MBSS.

All ADD Endoscopists are CCC-SLP's licensed in your state and, if desired, your facility can bill for their services.

There is no need to transport your patient out of the facility for a FEES.

Patients who are bed-bound, on Isolation precautions, or connected to critical monitors benefit from FEES due to its ability to be performed bedside.

Your patient's size or positioning restrictions (obesity, hip precautions/fusion, contractures, pain, kyphosis, torticollis, etc.) are not barriers for a FEES.

No concern of radiation exposure exists with a FEES.

Your patient consumes normal food and liquids during the FEES. No barium is required, which can be difficult to eat (especially for confused patients) and can be constipating, potentially remaining in the colon for up to 6 weeks.

There are no time limitations for a FEES. If indicated and necessary, your patient's swallow function can be evaluated for the entire duration of a meal.