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FEES: The Answers for Swallowing Difficulties

If your loved one is coughing during meals, avoiding certain foods, experiencing pneumonia, or showing changes in swallowing safety, guessing is not enough. At Speech Swallowing & Neurological Rehabilitation (SSNR), we provide Fiberoptic Endoscopic Evaluation of Swallowing (FEES). 

This gold standard swallowing study allows us to directly see what is happening inside the throat during swallowing. Because we say it often: We cannot treat what we cannot see.

FEES helps families to:

  • Identify the true cause of swallowing difficulties
  • Reduce risk of aspiration and pneumonia
  • Create safe, personalized eating recommendations
  • Provide targeted, evidence-based therapy
  • Give you clarity instead of uncertainty
Schedule a FEES Consultation

What Is a FEES?

A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) involves passing a small, flexible camera through the nasal cavity to view the larynx and airway from above.

During the procedure:

  • A small camera is gently passed through the nose
  • We view the throat structures in real time
  • Foods and liquids are colored with food dye for clear visualization
  • We assess safety and efficiency of the swallow
  • We determine if food or liquid enters the airway — when, how much, and why

We observe:

  • Whether material is moving safely into the esophagus
  • If food or liquid is entering the lungs
  • If material is staying somewhere it shouldn’t
  • If anything is coming back up into the throat

This detailed visualization allows us to determine exactly how to rehabilitate the swallow. 

And you don’t have to wait to get the answers you’re looking for. Unlike hospital systems that often have 8–12 week delays, we can typically schedule a swallow evaluation within one week.

Why a “Bedside Swallow Evaluation” Isn’t Enough

A bedside evaluation involves giving food or liquid and observing whether someone coughs. Often, swallowing disorders are not that simple.

Sometimes:

  • A person coughs due to medication side effects, not a swallowing problem
  • A person does not cough,  but food or liquid is silently entering the lungs
  • Everything looks fine externally, but there is internal dysfunction
  • This is called silent aspiration. There is no way to detest silent aspiration, which is when material enters the lungs without a protective cough response. 
adults eating outdoors at a picnic table

If someone fell and hurt their leg, we would not guess it was broken. We would image it to determine the severity of the break and how to treat it properly. A swallow study works the same way. Without imaging, we are simply guessing.

This evaluation helps us to: 

  • See which structures are not moving correctly
  • Identify timing or strength deficits
  • Detect silent dysfunction
  • Provide the most targeted, functional treatment possible
man and woman holding each other on a bench outdoors

If you are not getting a swallow study, you cannot confidently determine whether an exercise program is necessary, helpful, or worth your time.

Again: We cannot treat what we cannot see.

Benefits of FEES

FEES offers several important advantages:

  • No radiation exposure
  • No barium required
  • Can be done in the comfort of our office
  • Detailed color visualization of throat anatomy
  • Allows easy repeat testing to track progress
  • Can assess fatigue across a full meal
  • Allows real-time testing of strategies and exercises
  • Enables trial of preferred foods and medications

Because we can repeat the study, we can objectively determine whether therapy is making a measurable difference.

FEES helps to evaluate individuals with:

  • Parkinson’s disease and other neurodegenerative conditions
  • Dementia and cognitive changes
  • Stroke and traumatic brain injury (TBI)
  • COPD, chronic cough, and respiratory disease
  • Head and neck cancer
  • Voice disorders and reflux-related symptoms
  • Unexplained coughing or choking
  • Recurrent pneumonia
  • Any change in swallow safety

What Families Gain from FEES

By completing a FEES evaluation at SSNR, families gain:

Clarity: Immediate answers about what is happening

Safety: Clear recommendations to reduce aspiration risk

Confidence: Understanding which foods and liquids are safe

Direction: A targeted therapy plan based on visualization

Coordination: Results shared with your medical team

Getting Started

Swallowing changes can be frightening, but guessing is not the answer.

A swallow study provides clarity.

Clarity provides direction.

Direction allows for safe, effective treatment.

If your loved one is experiencing any change in swallow safety, schedule a FEES evaluation today.

Schedule a Swallowing Evaluation Today