Week 10

Question 1

How is an FEES (fiberoptic endoscopic evaluation of swallowing) performed?

Answer 1

Insert endoscope along nasal cavity floow with tip hanging freely in the oropharynx just in inferior to the velum at rest during breathing

Question 2

What structures can the examiner see during FEES?

Answer 2

Tongue base
Epiglottis
Piriform sinsues
Posterior cricoid area
Laryngeal structures

Question 3

What are other names for FEES?

Answer 3

(FEESS)Fiberoptic Endoscopic Evaluation of Swallow Safety
(FEESST)Fiberoptic Endoscopic Evaluation of Swallow Safety and Sensory Testing
Endoscopic Evaluation of Swallowing

Question 4

What is added to the (FEESST)Fiberoptic Endoscopic Evaluation of Swallow Safety and Sensory Testing

Answer 4

Touch arytenoids to test for cough

Question 5

What are the limitations of FEES?

Answer 5

No oral phases
‘White out’ during swallow (difficulties with assessing penetration and aspiration)
No measurement available/normalized data for comparison

Question 6

Whar are the indications for FEES?

Answer 6

Can be used is VFSS suite is not available/portable
Can be used as biofeedback
Those with a high risk of aspiration can be assessed without stimuli

Question 7

What is assessed with FEES?

Answer 7

general tissue health, symmetry, pooling
Velopharynx
Pharynx
Larynx
Swallowing trials

Question 8

How is the velopharynx assessed?

Answer 8

With scope bt inferior and middle turbinates observe velar elevation during sustained vowel, sustained /s/ and non-nasal sentence
Observe closure during dry swallow
Check for leakage during liquid swallow (opt)

Question 9

How is the pharynx assessed?

Answer 9

With scope in upper pharynx, ask pt to phonate /a/ and then a pharyngeal fricative

Examine for any pooled secretions in pyriforms, vallecula, pharyngeal walls, BOT and posterior cricoid

• If there is pooling, touch the area to assess sensation, then ask pt to swallow again
• If cleared, sensation may be impaired
• If not cleared, motor function may be impaired

Have pt execute high pitch elevation to test for pharyngeal constriction

Ask pt to hold nose and bear down to maximize pyriform sinus space

Have pt turn head from L to R and observe closure of the pyriform sinuses and any asymmetrical responses

Question 10

How is the larynx assessed?

Answer 10

With scope near tip of epiglottis
have pt phonate /i/ to oberve glottis closure, laryngeal elevation and vocal quality

Have pt conduct a pitch glide to observe changes in VF length, laryngeal elevation and pharyngeal constriction

Alternative /i/ and sniff for abduction and adduction of VFs

Observe true and false VF closure during breath hold tasks and coughing or throat clearing