Fibreoptic Endoscopic Evaluation of Swallowing Assessment Adelaide
FEES: Advanced Objective Swallowing Assessment
Adelaide Voice Therapy is proud to offer Fibreoptic Endoscopic Evaluation of Swallowing (FEES)—a state-of-the-art diagnostic tool used to assess swallowing function. FEES involves the gentle insertion of a thin, flexible camera through the nose to provide a clear, real-time view of your throat and vocal cords while you swallow different foods and liquids. This gold-standard procedure helps identify swallowing difficulties safely and accurately, without the need for radiation or hospital visits.
Expert-Led Swallowing Assessments with FEES:
Our FEES assessments are conducted by a team of highly skilled speech pathologists with advanced training in this specialised area. The service is supported by Specialist Laryngologist Dr Theo Athanasiadis, who provides expert medical oversight and guidance on any interventions that may help improve voice and swallowing function. FEES allows us to accurately identify the cause of swallowing difficulties, evaluate how well treatment strategies are working, and track progress over time for individuals with ongoing swallowing concerns. Assessments are held at our City Clinic, conveniently located at 191 Wakefield Street, Adelaide, within the rooms of Adelaide and Hills ENT.
FEES gives valuable insight into swallowing function
Signs and Symptoms That Can Indicate The Need For FEES:
Swallowing is something most people do without thinking, but for some, it can become difficult, uncomfortable, or even dangerous. If you’ve experienced any of the following symptoms, it may be a sign that your swallowing isn’t working as well as it should. A FEES (Fibreoptic Endoscopic Evaluation of Swallowing) assessment can help identify the problem and guide your treatment.
- History of known dysphagia/swallowing difficulty
- Recurrent chest infections that may be suspicious for aspiration pneumonia
- Frequent coughing or throat clearing when eating and drinking
- Choking episodes
- Regurgitation of foods or liquids
- Drooling or the sensation of saliva collecting in the throat
- A change in voice quality when eating or drinking (wet or gurgly)
- Difficulty coordinating swallowing and breathing
- Odynophagia (pain when swallowing)
- Difficulty finishing a meal due to fatigue
- Food sticking in the throat during mealtimes or the sensation of a lump in the throat (globus pharyngeus)
- Slow initiation of the swallowing reflex
Yes, FEES (Fibreoptic Endoscopic Evaluation of Swallowing) is generally a very safe procedure, with a low risk of complications. The most common experience is mild discomfort as the small, flexible endoscope is passed
through the nose, but this usually subsides once the endoscope is positioned in the throat.
Complications are extremely rare, but may include:
- Nosebleeds (epistaxis) – Occurs in about 1.2% of cases
- Fainting (vasovagal response) – A very rare occurrence in about 0.1% of cases
- Laryngospasm (temporary tightening of the vocal cords) – Happens in about 0.07% of cases
While these side effects are uncommon, your healthcare team will discuss any concerns with you beforehand to ensure you’re fully informed and comfortable throughout the process. FEES is a well-established and safe procedure to help assess and improve your swallowing function.
FEES is a simple, safe, and quick procedure that helps us understand how well you’re swallowing. Here’s what you can expect:
- Preparation
You’ll be asked to sit comfortably in a chair, and we’ll explain the procedure to make sure you feel at ease. There’s no need for any special preparation beforehand. - The Endoscope
A small, flexible tube (called an endoscope) will be gently inserted through your nose. It’s very thin, and you may feel some mild discomfort as it passes through your nostril, but this usually doesn’t last long. - Positioning the Endoscope
Once the endoscope is in place, it will be positioned at the top of your throat. The endoscope has a tiny camera on the end that allows us to see your throat and vocal cords clearly on a screen while you swallow.You will also be able to watch the screen in real-time, or if you prefer, we will play it back to you at the end of the assessment to show you the results and help you better understand your swallowing function. - Swallowing Test
You’ll be asked to swallow different foods and liquids, which will be specially prepared for the test so they can be seen on the screen. We’ll observe how the food moves through your throat and watch for any signs of difficulty or aspiration (when food or liquids go into the wrong part of your airway). You may also be asked to swallow food with different textures or try different swallowing techniques to see how your swallowing functions change. We can accommodate your dietary needs and you may have the opportunity to try foods or drinks that you find challenging so that we can understand why this is occurring. - Analysis and Feedback
During the procedure, we’ll closely monitor how well your swallowing works. The camera will show real-time images, allowing us to identify any issues, such as difficulty swallowing or potential risks of choking or aspiration. Afterward, we’ll discuss the findings with you and your doctor to decide on the next steps for your treatment or care. - After the Test
Once the procedure is complete, the endoscope will be carefully removed, and you can go back to your usual activities. Most people feel fine afterward and can resume eating and drinking as usual, unless otherwise advised.
FEES is a valuable tool for assessing oropharyngeal swallowing function.
FEES Information for Health Professionals:
Referral Criteria for FEES (Fibreoptic Endoscopic Evaluation of Swallowing)
FEES is a valuable tool for assessing oropharyngeal swallowing function. Suitable patients for referral include those with:
- Suspected oropharyngeal dysphagia – Symptoms may include coughing, choking, throat clearing, or voice changes during or after meals.
- Recurrent respiratory infections or aspiration pneumonia – Particularly where aspiration of food, fluids, or secretions is suspected.
- Neurological conditions – Such as stroke, Parkinson’s disease, multiple sclerosis, motor neuron disease, or traumatic brain injury, where dysphagia is commonly observed.
- Progressive neurodegenerative diseases – For ongoing monitoring of swallowing function to guide clinical management and nutritional planning.
- Post-surgical or structural abnormalities – Including head and neck cancer resections, anterior cervical discectomy and fusion (ACDF), or suspected pharyngeal/laryngeal lesions affecting the swallow.
- Unexplained weight loss or malnutrition – Where dysphagia may be a contributing factor.
- Post-tracheostomy or decannulation – To evaluate swallowing function following airway changes.
- Assessment of compensatory or rehabilitative interventions – Including postural adjustments, texture modifications, or targeted swallowing exercises.
- As an alternative to Videofluoroscopy (VFSS) when VFSS is contraindicated or inconclusive
FEES is a safe and radiation-free procedure that provides a detailed view of the throat during swallowing. It allows clinicians to assess real food and liquid intake without contrast, observe vocal fold movement, and evaluate the health of the mucosa and laryngeal function. FEES is ideal for detecting trace amounts of aspiration and residue and is a useful tool for assessing the effectiveness of compensatory swallowing maneuvers. Its ability to assess both motor and sensory aspects of swallowing makes it a highly effective and efficient tool for diagnosing and managing swallowing disorders.
Contraindications for FEES may include but are not limited to:
- Base of skull or facial fracture
- Recent sino-nasal anterior skull base surgery or tumours
- Agitation with poor ability to tolerate a nasendoscopy
- History of frequent vasovagal or fainting episodes
- Obstruction of both nasal passages, nasal trauma or nasopharyngeal stenosis
- Severe movement disorder with inability to tolerate a nasendoscopy
- History of severe epistaxis
- Unstable cardiac conditions
- Poor mucosal condition is suspected and nasendoscopy may cause trauma
- Currently taking anticoagulation medication – discuss suitability with our team
- Recent treatment for head and neck cancer – discuss suitability with our team
Where FEES is contraindicated but there is still a need for swallowing assessment, the patient will be offered:
- a clinical swallowing assessment
- On-referral for a Video Fluoroscopic Swallow Study (VFSS)
- FEES conducted in conjunction with an Ear Nose and Throat Specialist and the Speech Pathologist
- Langmore, S.E. (2001). Endoscopic Evaluation and Treatment of Swallowing Disorders. Thieme.
- Martin-Harris, B., et al. (2008). “Manual of Dysphagia Assessment in Adults”. Plural Publishing.
- RCSLT (Royal College of Speech and Language Therapists). (2021). Clinical Guidelines for Endoscopic Evaluation of Swallowing in Adults.
- National Institute for Health and Care Excellence (NICE). (2019).
- Speech Pathology Australia Fibreoptic Endoscopic Evaluation of Swallowing Best Practice Guidelines