Dysphagia Exam 2: Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

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janessamarie
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279761
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Dysphagia Exam 2: Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Updated:
2014-07-26 17:28:59
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FEES swallowing evaluation
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How FEES works and its pros/cons with VFSS
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  1. Answer with VFSS, FEES, or both for each clinical condition. **TEST**
    Oral stage dysphagia
    UE or esophageal stage dysphagia 
    Vague complaints
    Clinically inexplicable weight loss
    Initial exam for long-standing dysphagia
    Food stuck at thyroid notch or lower
    sudden onset of pharyngeal dysphagia
    food stuck above thyroid notch
    retest, pharyngeal dysphagia
    biofeedback, pharyngeal dysphagia
    Aspiration of secretions
    anatomic anomalies
    assess airway protection patterns
    fluoroscopy unavailable
    • VFSS
    • VFSS
    • VFSS
    • VFSS
    • VFSS
    • VFSS
    • BOTH
    • BOTH
    • BOTH
    • BOTH
    • FEES
    • FEES
    • FEES
    • FEES
  2. What is the purpose of FEES?
    • Info about structural condition of pharynx and hypo pharynx
    • Assess adequacy of critical pharyngeal stage of swallow
    • Presence of aspiration
  3. What is the FEES procedure?
    • Varies
    • Anesthesia (small amount of topical), vasoconstrictor may be applied to reduce discomfort 
    • Nasal insertion (middle nasal meatus preferable, easier to visualize VP function)
    • Scope positioning (nasopharynx-vp closure during swallow, oropharynx- above superior tip of epiglottis, laryngeal vestibule-superior to ventricular folds)
  4. What is the swallow assessment?
    • Scope in nasopharynx to view vp function
    • Assess closure, may use dye in saliva to aid view; dry swallow; incomplete vp closure may see saliva coming through vp port

    • Advance through vp port to oropharynx
    • Hold small bolus, watch for premature leakage, only assessment of oral stage, swallow, inspect hypo pharynx for residual liquid pooling in pyriform or valleculae, aspiration after swallow

    • Advance scope into laryngeal vestibule (penetration or tracheal aspiration, residue on pharyngeal surface of epiglottis, superior surface of ventricular folds, superior surface of tvf)
    • Visualize tracheal walls for residue or staining
    • Evaluate other consistencies in similar manner
  5. Assessment of maneuvers
    Experimentation with compensatory strategies and/or biofeedback

    Chin tuck, head rotation, supraglottic swallow, mendelsohn maneuver
  6. Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST)
    • Addition of sensory testing to FEES, precedes liquid/food trials; variable pulses of air delivered through endoscope, assess VF closure int espouse to stimulation
    • Administration of discrete
    • Pulses of air to trigger swallow
  7. Results of FEES
    What are questions answered?
    • Dietary modification
    • Therapeutic techniques 
    • Abnormal results may indicate need for VFSS
    • Questions answered: aspiration before swallow, residue after swallow, reduced pharyngeal tone

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