FEES Flashcards
Fiberoptic Endoscopic Evaluation of Swallowing
- FEES
1. Used to examine the pharyngeal swallow initially in l988
2. Used as an alternative when MBS was not available
3. Widely used today
4. A FEES is not a screening tool.
5. A FEES is a 3-D evaluation by SLP’s of:
a. Anatomy & physiology of the pharynx & larynx
b. Swallow function
c. Postural, dietary and behavioral strategies.
6. FEES is not a duplicate of fluoroscopy but can reveal some unique findings and may be the preferred examination for a patient with dysphagia.
2 Components of FEES training
- Knowledge based
- Hands on practice- 10 normal subjects and 15 abnormal subjects
Our code of ethics: “engage only in those practices that are within our scope of competence.” (If we are not competent we shouldn’t be doing it)
MD vs SLP
- MD: most interested in diagnosing the underlying medical problem causing dysphagia
- SLP is interested primarily in identifying a dysphagia, understanding the nature of the dysphagia and planning treatment.
Time of Endoscopy
- Endoscopy is not time restrained as fluoroscopy is.
2. We can stay in the nose while the patient eats their entire meal- can watch for fatigue
Pros of Endoscopy (5)
Repeat endoscopy exams can be done more easily and with less hesitation than fluoroscopy because they:
- Cost less
- Deliver no radiation
- Can be brought to the patient
- Can be used as biofeedback
- Can observe patient in their natural feeding environment
*** Can perform more than 1 time in a day if you need to.
Five components of FEES
- Assessment of anatomy of the pharyngeal stage as it affects swallowing (can only see this stage)
- Assessment of movement and sensation of critical structures within the hypopharynx and laryngopharynx
- Assessment of secretion management (MBS cannot do this)
- Direct assessment of swallowing function for food and liquid
- Response to therapeutic maneuvers, interventions and behavioral strategies to improve safety & efficiency of the swallow.
Indications for a FEES exam (9)
- Positioning in fluoroscopy problematic
- Transportation to fluoroscopy problematic
- Concern about excess radiation exposure
- Severe dysphagia with very weak or possibly absent swallow response
- Post-intubation or post-surgery. Endoscopy can visualize larynx directly for signs of trauma or neuro damage
- Tracheostomy if you suspect laryngeal competence may be compromised (don’t have a passy muir speaking valve)
- Need to assess fatigue or swallow status over a meal
- Repeat exam to assess change; to assess effectiveness or need for maneuvers
- Biofeedback- can reassess a chin tuck with FEES
Do FEES when patient demonstrates: (5)
- Hypernasal voice
- Hoarse, breathy voice, or aphonic
- Wet voice quality
- Rapid respiratory rate; effortful breathing (can they hold their breath well enough to swallow)
- Inability to handle saliva/secretions
a. Good for these because you will get to see the larynx and VF.
FEES limitation
- Can not see aspiration during the swallow – can only infer.
a. Can see before and after
Indications for Fluoroscopy (7)
- Patient will not accept/tolerate endoscopy
- Suspected oral stage problem that should be imaged
- Esophageal stage problem or GER suspected
- Globus complaints, possible CP dysfunction
- Vague symptomotology from patient
- Need to verify aspiration of thin liquids during the swallow
- Need to get better impression of amount of aspiration.
Risks of Endoscopy/Contraindications (9)
- Agitated; tactily defensive patient
- Hyperactive gag reflex- should be off velum and back of the tongue
- Small nasal passage (nasal stenosis)
- Pharyngeal stenosis
- Not sufficiently alert to be fed orally
Patient has movement disorder (chorea)
- Need two people- someone to feed and someone to do the scope
6. H/o epistaxis (nose bleeds)
7. Bleeding disorder
8. History of fainting
9. Acute cardiac problems which predispose to bradycardia
** = have medical help present or don’t do FEES
Adverse Reactions- (7)
- Discomfort – most common
- Gagging/vomiting
- Nose bleed/perforation
- Laryngospasm- need to touch the larynx and VF
- Vasovagal response- fainting
- Tachycardia
- Nasal inflammation
Study of 6000 exams – 73 examiners
a. 20/6000 (.3%) epistaxis- bloody nose
b. 2/6000 (.03) fainted
c. 2/6000 (.03) laryngospasm
Universal precautions (3)
- Gloves
- Eye protection – optional
- Endoscope high-level disinfection
Endoscopic equipment (6)
- Flexible endoscope
- Light source
- Camera and adapter
- Video recorder and monitor
- Optional: air pulse generator for sensory testing (FEESST)- burst of air into the throat to observe sensation
- Miscellaneous supplies
Positioning
- Position the patient in a posture that is typical of how he or she eats
- Position the patient in a posture that would be preferred over the current posture and is realistic for the setting.