Flexible Endoscopic Evaluation of Swallowing (FEES)
What is FEES
Flexible Endoscopic Evaluation of Swallowing (FEES) is an instrumental procedure used to evaluate swallowing function. It requires the use of a flexible laryngoscope that is passed transnasally and positioned to view the base of tongue, pharynx, and larynx before/during/after the swallow. It can be used as a primary, interval, or adjunct assessment in individuals of any age who are referred for a dysphagia evaluation.”
Langmore et al. (2022). Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1
Why Do SLPs Need Imaging
SLPs cannot treat what they cannot see. SLPs need imaging from FEES or MBSS to see what is going on with the swallow in order to accurately and effectively manage and treat the underlying cause.
Bedside evaluations can over or under diagnosis of dysphagia: One study showed SLP missed 14% of patients who were aspirating and over-diagnosed aspiration by 70% (Leder & Espinoza, 2002)
Benefits of FEES
Thickening Liquids is not cheap. The costs for thickened liquids per patient range from $174 to $289 monthly, amounting to $2,088 to $3,468 annually (Desai, 2019). Therefore, 5 patients on thickened liquids can cost the facilitate over $10,000 a year.
Re-hospitalization: Adults tend to not drink enough water and have a higher risk of dehydration (Bunn et al., 2019). Thickened liquids further increase dehydration risk. Thickened liquids also have been proposed to interfere with the absorption of medications and nutrients in foods, reducing the efficacy of medications and increasing malnutrition risk (Cichero, 2013). Various studies have looked at the top five primary diagnoses for patients re-admitted to hospitals within 30 days of discharging to an SNF:
63% of 30-day re-admissions: congestive heart failure (CHF), urinary tract infection (UTI), renal failure, pneumonia, and chronic obstructive pulmonary disease (COPD) (Ouslander et al., 2011)
78% of 30-day re-admissions: dehydration, malnutrition, electrolyte imbalance, sepsis, and/or UTI (Mor et al., 2010)
Cost for transport to hospital for PEG complications, Modified Barium Swallow Studies, or hospitalizations due to pneumonia, weight loss, malnutrition.
2. Create treatment plans that target the specific impairment. Therefore, individuals' quality of life will improve as SLP can provide exercises to improve the impairment and/or provide compensatory strategies that will allow individuals to safely eat and drink while reducing the risk of aspiration, pneumonia, dehydration, weight loss, social isolation, and re-hospitalizations.
3. Report with impressions, recommendations, and treatment plans provided on the same day.