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FEES vs MBSS/VFSS

FAQs

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What is FEES?

FEES, or Fiberoptic Endoscopic Evaluation of Swallowing, is a specialized diagnostic procedure used to assess swallowing function in individuals with dysphagia. Conducted by a qualified and licensed Speech-Language Pathologist (SLP) endoscopist, all evaluations are performed on-site, ensuring convenience and efficiency. During the procedure, a thin, flexible tube with a camera is passed through the nose and into the throat, allowing for real-time visualization of the swallowing process. All patients are administered the same standard swallowing assessment protocol, designed to stress the swallowing mechanism and reveal any disorders and their underlying causes. Marigold Speech provides all food products for the evaluation, and a final printed report—including color pictures, complete findings, and recommendations—is given to your facility's SLP. Marigold Speech clinicians collaborate directly with your facility’s SLP and staff to determine the most appropriate diet suggestions, ultimately leading to improved hydration, nutrition, and overall quality of life for patients.

Is FEES new?

No! Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is not a new procedure; it has been used in clinical practice since the 1980s. Over the decades, it has become a trusted and essential tool in the assessment of swallowing disorders, continually evolving with advancements in technology and clinical practices. Its established history in the field of speech-language pathology highlights its effectiveness and reliability in diagnosing and managing dysphagia, making it a cornerstone of modern swallowing evaluations.  

FEES has revolutionized the field of dysphagia diagnostics and management as practical and valuable alternative to an Modified Barium Swallow Study (MBSS/VFSS)  to decrease risk of aspiration pneumonia.  Across the nation, FEES is now being utilized more often than an MBSS due to the lower cost, portability, convenience and reliability of findings.  

 

For additional information on the evolution of FEES, see History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years.  Dr. Susan E. Langmore.  Dysphagia (2017) 32:27-38

Why is imaging crucial?

Flexible Endoscope path depicted in a cross section of an airway

Imaging from an instrumental examination like FEES is crucial for dysphagia as it provides detailed visualization of the swallowing process, allowing clinicians to assess the anatomy and function of the throat, larynx, and esophagus in real time. This examination helps identify any aspiration, which is vital for determining the safety of swallowing and preventing complications like pneumonia. Additionally, FEES evaluates both the motor and sensory components of swallowing, pinpointing specific deficits that may contribute to dysphagia. The information gathered can guide personalized treatment plans, dietary modifications, and strategies to improve swallowing function. Furthermore, repeated assessments can track progress over time, offering valuable insights into the effectiveness of interventions. Overall, FEES is essential for accurate diagnosis, treatment planning, and ongoing management of dysphagia.

Can't my team just downgrade to thicken liquids?

While we can downgrade a patient's diet, it's important to recognize that a long-term downgrade is often not the goal and may not be clinically justified. This shouldn't be the long-term plan either. In fact, certain swallowing exercises and strategies, such as using thickened liquids, can sometimes harm patients and increase the risk of re-hospitalization if applied unnecessarily.

Marigold Speech Mobile FEES understands the challenges faced by residents who are often restricted diets and thickened liquids, which can lead to weight loss and aspiration pneumonia, especially if they are too weak or medically compromised to travel for a swallowing assessment. Our onsite Mobile FEES service provides a solution to this issue.

What is the evidence behind imaging?

Video imaging is vital for accurately detecting aspiration, especially silent aspiration, as well as other structural abnormalities that affect swallowing, providing essential information for Speech-Language Pathologists, physicians, and the care team. Research has shown that bedside swallowing exams can have up to a 70% error rate, often leading to overly restrictive recommendations that result in dehydration or malnutrition, or failing to identify silent aspiration, which can lead to pneumonia. Even experienced therapists can diagnose swallowing function accurately only 60-75% of the time with bedside and mealtime assessments. In contrast, studies consistently demonstrate that FEES and MBSS/VFSS have 97-100% inter-rater reliability, with FEES showing superior specificity and accuracy in identifying issues like penetration, aspiration, residue, and spillage. What does this mean? Imaging is supported by evidence-based research. It not only aids your SLPs in developing effective treatment plans that enhance resident outcomes, but it also boosts resident satisfaction and overall quality of life.

FEES in a nutshell.

1

Cost Effective

FEES is conducted at a lower cost than traditional instrumental assessments, with facilities typically seeing a 40-50% reduction in expenses when opting for mobile FEES instead of hospital-based video swallow studies (MBSS/Modified Barium Swallow Study).

2

Evidence Based

FEES helps determine if silent aspiration is occurring, reduces the risk of rehospitalization, and enhances the accuracy of diet modifications. It also supports resident and family-centered assessment education and recommendations, ultimately leading to improved satisfaction among patients and their families.

3

Prompt Outcomes

Say goodbye to costly, exhausting transportation and lengthy waits for outpatient appointments. We can provide a FEES procedure for your resident within 1-3 business days of referral, and you’ll receive the assessment report within 24 hours.

For more information, click the button below to visit our frequently asked questions.

WHY CHOOSE MARIGOLD SPEECH

PATIENT CENTERED CARE
COLLABRATIVE APPROACH
TIMELY AND ETHICAL SERVICE
ULTIZING GOLD STANDARDS FOR DYSPHAGIA
PROVEN INNOVATION TECHNOLOGY

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