Mobile FEES PROVIDER
dYSPHAGIA SPECIALISTS
What Is a FEES?
FEES stands for Fiberoptic Endoscopic Evaluation of Swallowing. It is an instrumental swallowing assessment performed at the bedside using a thin, flexible endoscope passed through the nose to view the throat directly during eating and drinking.
FEES is now one of the two standard instrumental assessments for oropharyngeal dysphagia, alongside the videofluoroscopic swallow study (VFSS, or modified barium swallow). It is a specialized evaluation requiring additional training and extensive knowledge of the swallowing mechanism.
How the Evaluation Works
Step 1: Consultation
Our speech-language pathologist reviews the chart, confirms the physician order, and discusses history with staff.
Step 4: Swallowing Trials
The patient eats and drinks real food of varying textures while we watch the pharynx and larynx in real time.
Step 2: The Pass
A thin endoscope is passed through the nostril. This is done bedside without the patient needing to be transported.
Step 5: Intervention
We test strategies during the evaluation which may improve swallow safety, pharyngeal clearance and/or airway protection.
Step 3: Observation
We assess anatomy at rest: secretion management, vocal fold movement, sensation, and airway protection.
Step 6: Report
A printed report is provided before exiting the building. The report includes diet recommendations, therapy recommendations, follow up recommendations and comprehensive evaluation of oropharyngeal swallow function and safety.
What a FEES Identifies
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Whether food or liquid enters the airway, and whether the patient responds
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Silent aspiration — airway invasion without a cough response
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Pharyngeal residue after the swallow, and where it collects
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Secretion management and pooling
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Vocal fold movement and laryngeal sensation
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How swallowing changes across time as the patient fatigues
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Anatomical findings that warrant physician follow-up
See why FEES is well suited to skilled nursing and long-term care residents.
Is it Safe?
FEES is a low-risk procedure with an extensive safety record. When complications occur, they are minor and resolve on their own.
Under 1% — complication rate across published series of 2,820 and 5,680 examinations. Events recorded were nosebleed (0.14%), vasovagal response or brief fainting (0.1%), and laryngospasm (0.07%). All resolved spontaneously with no lasting effects.
1.14% — complication rate in a 2025 study of 964 examinations: four cases of laryngospasm, three of vomiting, one nosebleed, and three procedures stopped early for patient comfort. No airway compromise, no vasovagal episodes, and no case required medical intervention. The study also found no difference in safety between exams performed by speech-language pathologists (1.05%) and physicians (1.23%).
Zero — significant complications among acute stroke patients scoped within 48 hours of admission, including no nosebleed, no change in consciousness, and no heart rate disturbance.
Most common by far: momentary discomfort as the scope passes, and occasional gagging. Neither requires stopping the evaluation.
Worth knowing: laryngospasm — a brief closure of the vocal folds — appears more often in patients with advanced neurodegenerative disease, particularly ALS. We screen for this and adjust our approach accordingly.
Our clinicians hold sole clinical judgment during every evaluation and will decline or discontinue any study that poses unreasonable risk to the patient.
Ready to schedule?
Ready to see whether FEES is right for your patient or facility? We bring bedside FEES directly to your building, with same-day reports and clear, actionable recommendations. If your facility already has an agreement with us, request a FEES below. If you would like to discuss getting set up, please reach out with any questions.
References
Nacci, A., Matteucci, J., Romeo, S. O., Santopadre, S., Cavaliere, M. D., Barillari, M. R., Berrettini, S., & Fattori, B. (2016). Complications with fiberoptic endoscopic evaluation of swallowing in 2,820 examinations. Folia Phoniatrica et Logopaedica, 68(1), 37-45. https://doi.org/10.1159/000446985
Nacci, A., Simoni, F., Pagani, R., Santoro, A., Capobianco, S., D'Anna, C., Berrettini, S., Fattori, B., & Bastiani, L. (2022). Complications during fiberoptic endoscopic evaluation of swallowing in 5,680 examinations. Folia Phoniatrica et Logopaedica, 74(5), 352-363. https://doi.org/10.1159/000521145
Polit, M., Chmielewska-Walczak, J., Sobol, M., Domitrz, I., & Niemczyk, K. (2025). Safety of FEES performed by speech-language pathologists and physicians: Evidence supporting task sharing from a retrospective observational study of 964 consecutive examinations. Nutrients, 17(20), 3193. https://doi.org/10.3390/nu17203193
Warnecke, T., Teismann, I., Oelenberg, S., Hamacher, C., Ringelstein, E. B., Schabitz, W. R., & Dziewas, R. (2009). The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke, 40(2), 482-486. https://doi.org/10.1161/STROKEAHA.108.520775