Speech language pathologists at Duke use fiberoptic endoscopic examination of swallowing to evaluate the swallowing mechanism as you drink liquids and eat solid food.

What is the purpose of the FEES?

The purpose of the examination is to determine if there is aspiration (food or liquid going into the airway) during or after swallowing, or if food and liquid is remaining in the throat after the swallow.

From this test, the speech language pathologist makes recommendations in collaboration with your physician for safer swallowing. These recommendations may involve changes to the consistency of food and liquids you eat and drink (for example, thicker liquids or softer foods), based on the results of the exam.

The FEES also allows the speech-language pathologist to evaluate the movement of the vocal folds. This is important for patients with possible vocal fold paralysis.

The speech language pathologist can determine how the vocal fold paralysis is affecting your swallowing, and may try some simple postural changes that often make swallowing safer in these cases.

How is the evaluation done?

The FEES is usually completed in the doctor’s examination room by the speech language pathologist. This test uses a fiberoptic endoscope, which is a long tube, approximately the diameter of a piece of spaghetti, with a tiny camera at the end.

The fiberoptic endoscope is connected to a video monitor, so the examination can be seen on the monitor, recorded, and viewed again as needed.

As you are seated in an exam chair, the fiberoptic endoscope is inserted into one side of the nose and placed in the top of the throat.

From that position, the camera can visualize the throat just before and after swallowing, so the speech language pathologist can see if food and liquid are going into the food tube (esophagus) normally, or whether any food or liquid is going into the airway towards the lungs (aspiration).

During the exam, with the endoscope placed in the top of the throat, you may be given small amounts of liquid (which may vary in thickness from thin, to nectar thick, to honey thick), puree or pudding, and a soft food, all coated with green food coloring so they can be seen more clearly on the camera.

You may be asked to swallow teaspoon-sized amounts of liquid, or cup sips, or sips from a straw.

The speech language pathologist may ask you to use a postural change (turning your head right or left, or tucking your chin towards your chest) as you swallow, as these techniques sometimes prevent aspiration and make the swallowing safer.

When will I know the results of the test?

You will receive the results immediately following the evaluation, pending approval by your doctor.

How long does the test take?

The test itself takes about five to 10 minutes, but the appointment will last longer to allow for education about swallowing, explaining your results, and counseling you on any recommendations for safest swallowing.

Do I need to do anything to prepare for the test?

No. You can eat and drink normally before and after the examination.

Please let us know if you have  allergies to any food or food coloring, if you have a history of frequent nosebleeds, or if you are on a blood-thinning medication, so that we can schedule the most appropriate swallowing evaluation for you.

This article is intended as a resource for patients receiving their voice care at Duke Voice Care Center. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.