Evaluation of Swallowing
A procedure used to assess patients with
dysphagia and taught around the world
FEES is a procedure used to evaluate patients with dysphagia. It is done throughout the US and in all countries that have established programs to evaluate and treat patients with dysphagia. It is also becoming the most common instrumental procedure in developing countries that are forming dysphagia teams and learning more about best clinical practices. FEES has an advantage over fluoroscopy in these countries, as the equipment is less costly and it can be used in a variety of settings, even taken to bedside.
For those who are not familiar with the procedure, using a flexible laryngoscope and camera, the base of tongue, throat and larynx can be visualized. When the person eats and drinks, the examiner is able to assess whether the swallow is normal or impaired. If impaired, the nature of the problem can be determined. Using dietary, behavioral, and postural interventions, the examiner then attempts to remediate the problem and determine how the patient can eat most safely and effectively.
PhD., CCC-SLP, BCSS
FEES is truly an international procedure. In the United States, the fluoroscopy procedure is more commonly done than FEES. But in some other countries, FEES is the first procedure of choice. The role of the physician and speech pathologist varies; in some countries, the endoscopist must be an MD whereas in others, the 2 professionals are more interchangeable, as in the US. Also the interaction with the patient is sometimes more formal than experienced in the US. The following is a list of countries where I know that FEES is done: If you know of more countries where FEES is done, please email me with more specifics.
I have conducted research virtually all of my career, alongside my clinical and teaching endeavors. My major interest is dysphagia. I am most interested in evaluation methods and outcomes, and, of course, any research involving the use of FEES. Recently, I was Principal Investigator on a multi-site clinical trial to determine the efficacy of electrical stimulation and/or aggressive exercise in patients with dysphagia after receiving radiation therapy for their head and neck cancer. Over my career, I have published more than 50 articles as primary or secondary author.
Over the years, my primary role has been that of a clinician. I have worked in the medical arena my entire career, evolving from a concentration in aphasia to dysarthria and finally to dysphagia. All of my career has been spent in clinical practice, serving acute care/ICU, rehab, and outpatients who have neurologic diseases, head and neck cancer, and other conditions that can cause dysphagia. It was a direct response to the needs of patients with dysphagia that motivated me to develop the FEES procedure in the mid 80s.
I have contributed service to the Dept of Veterans Affairs, to the American Speech Language Hearing Association (ASHA), and to the Dysphagia Research Society. I was made a fellow of ASHA in 1998 and was awarded the BCSS (Board Certified Specialist in Swallowing and Swallowing Disorders) in 2003. I was awarded the Honors of the Association in November, 2012. I am currently on the Editorial Board for the journal Dysphagia.
At BUMC, I am Professor in Otolaryngology where I mentor Speech Pathology graduate students and physicians, give lectures, and work with other faculty on research endeavors. I am also Clinical Professor in the Department of Speech Language, Hearing Sciences at Boston University, where, until this year, I taught graduate level courses in dysphagia and motor speech disorders. I serve as primary advisor to doctoral level students in Speech and Hearing Science at Boston University. The picture on the right shows students from my last Dysphagia class at BU.
The Foundation course is a 2-day basic course aimed at a range of clinicians: those with no experience to those who are currently using FEES. The faculty is made up of myself and/or other experienced speech pathologists who teach the course. We may have guest lecturers in pediatrics or otolaryngology. The participants are mainly SLPs who have experience performing modified barium swallow studies and are ready to add FEES to their daily practice. Some physicians attend who are interested in adding FEES to their practice; they often come as an SLP-MD team. Some graduate students are also in attendance.
The first day of the course covers the basics of FEES, from understanding swallowing as seen endoscopically, through the evaluation protocols, to scoring examinations, and finally to using endoscopy as a treatment tool. On the second day of the course, case studies are presented for practice scoring and we cover administrative issues to help you set up a FEES program and bill for your work. Along with every lecture are abundant video clips to aid in understanding. An extremely valuable part of the course is the 4 hours of hands-on training time where the participant will have practice passing the scope under direct mentorship of an experienced speech pathologist. We guarantee each participant at least 5 mentored passings of the laryngoscope so that an initial level of comfort and skill can be attained.
The cost for registration, including materials, breakfast, and lunch, is $600/person. If 2 or more people from the same institution attend, a reduced rate will be applied. Further discounts are offered if 3 or more persons from the same institution apply.
Videos of FEES Procedure
Photos of FEES Procedure
If you are interested in having a FEES course at your site, or have other questions, please contact us.