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Understanding FEES: A Better Way to Check Your Swallowing

Writer: Janis Billiot, MA CCC-SLP
Janis Billiot, MA CCC-SLP
Jul 30
3 min read

What Is FEES?

Side-view anatomy diagram of the nasal cavity and throat with a laryngoscope inserted through the nose on a white background

FEES stands for Fiberoptic Endoscopic Evaluation of Swallowing. It is a safe, well-established test used to check how well a person swallows food and liquids. During the test, a small, thin, flexible camera is gently passed through the nose to look at the throat while the person eats and drinks. The test is performed by a trained speech-language pathologist (SLP), sometimes together with an ear, nose, and throat (ENT) doctor.


Why Is a Swallowing Test Important?


Swallowing problems (called "dysphagia") are common in older adults, people recovering from stroke, individuals with neurological conditions like Parkinson's disease or dementia, and children with developmental or medical conditions. When swallowing doesn't work properly, food or liquid can go into the lungs instead of the stomach. This is called aspiration, and it can lead to:


  • Pneumonia (lung infection)

  • Malnutrition and dehydration

  • Choking

  • Reduced quality of life


Many people aspirate silently; meaning they show no outward signs like coughing, making it impossible to detect without a specialized test.


Why FEES Is a Great Option


It Comes to You


Unlike other swallowing tests that require a trip to a hospital or radiology suite, FEES is portable. The equipment can be brought directly to:


  • Your home

  • A skilled nursing facility (SNF)

  • An assisted living facility (ALF)

  • A long-term care facility (LTF)

  • A clinic or doctor's office


This is especially helpful for people who have difficulty traveling, are in wheelchairs, are bedridden, or become confused or agitated in unfamiliar settings.


No Radiation


The other common swallowing test, called a Modified Barium Swallow Study (MBSS) or videofluoroscopy (VFSS), uses x-ray radiation and requires swallowing barium (a chalky liquid). FEES uses no radiation at all, making it safe to repeat as many times as needed to track progress or adjust treatment plans. This is particularly important for children and for anyone who needs frequent monitoring.


You Eat Real Food


During FEES, you eat and drink your own food and liquids - not barium-coated substitutes. This gives a more realistic picture of how swallowing works during actual meals.


Safe for All Ages


FEES has been used safely in patients ranging from newborns (as young as 2 days old) to the very elderly. Over 25 years of experience with thousands of pediatric examinations has shown no significant adverse events. It is well tolerated by most adults and children.


Detects Problems Other Tests May Miss


FEES allows the clinician to directly see:


  • Whether saliva, food, or liquid enters the airway (aspiration and penetration)

  • How well the throat muscles are working

  • Whether food is left behind in the throat after swallowing

  • The structure and sensation of the throat and voice box


Some research has shown that FEES may be slightly more sensitive than the traditional X-ray swallowing test at detecting aspiration, penetration, and leftover food in the throat.


Helps Guide Treatment Right Away


Because the test is done in real time, the clinician can immediately try different strategies; such as changing the thickness of liquids, adjusting head position, or trying different food textures, and see what works best. This means a personalized treatment plan can be created on the spot.


Ideal for Nursing Home and Long-Term Care Residents


For residents of skilled nursing facilities, assisted living facilities, and long-term care facilities, FEES offers important advantages:


  • No need for transport to a hospital or imaging center, which reduces stress, fall risk, and cost

  • Can be done at the bedside, even for patients who are immobile or have altered mental status

  • Allows for repeat evaluations over time without radiation concerns

  • Supports care-in-place, keeping residents comfortable in their familiar environment

  • Can help reduce rates of aspiration pneumonia through earlier and more accurate detection of swallowing problems


Benefits for Children


For infants and children, FEES offers unique advantages:


  • Can evaluate swallowing during breastfeeding — something the X-ray test cannot do

  • No radiation exposure, which is especially important for growing children

  • Can assess the structure of the airway and throat for abnormalities

  • Can be repeated as the child grows to track changes in swallowing function


What to Expect During the Test


1. A thin, flexible camera is gently placed through one nostril.

2. You (or your child) will be asked to eat and drink various foods and liquids while the clinician watches on a screen.

3. The test typically takes about 15–20 minutes.

4. Results and recommendations are usually available immediately.


Is FEES Right for You or Your Loved One?


FEES may be recommended if there are concerns about:


  • Coughing or choking during meals

  • A "wet" or "gurgly" voice after eating or drinking

  • Unexplained pneumonia or lung infections

  • Weight loss or poor nutrition

  • Difficulty managing saliva

  • Any condition that affects the muscles or nerves used for swallowing


Talk to your doctor or reach out to Canopy Therapy Solutions to learn whether FEES is the right choice.


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