Fibreoptic Endoscopic Evaluation of Swallowing (FEES)

The FEES is not as commonly utilised as the VFS, as it is a newer technology. However it is gaining in popularity as an assessment instrument (Groher & Crary, 2010). During the assessment, the patient is required to consume food or liquid with natural or added colour. The swallow is then recorded in the pharynx by means of a flexible endoscope, which is inserted through the nasal cavity, and faces inferiorly towards the hypopharynx (Langmore & McCulloch 1997).

The FEES allows the practitioner a clear view of the oral pharynx, the hypopharynx, and the vocal cords inside the larynx; enabling various examinations to be performed (Langmore & McCulloch 1997). In the case of COPD patients, the primary difficulty with swallowing is the coordinating of breathing. Therefore, many of the assessments in a FEES regarding anatomical structure, secretions and pharyngeal function will not indicate dysphagia in COPD patients. Moreover, at the point of maximum hyoid elevation in a swallow, the endoscopic camera will be obstructed, and briefly unable to record the physiology of the swallow (Langmore & McCulloch 1997).

The following abnormalities in swallowing physiology may be observed in a FEES when assessing a patient with COPD:

  • Early and longer airway closure durations
  • Bolus residue in the pharynx post swallow, indicating risk of aspiration
  • Penetration of food into the laryngeal vestibule
  • Rapid breathing; possibly predicting coordination difficulties with the swallow

While the FEES does not allow for clear evidence of aspiration or the degree of hyoid elevation, it does have several benefits over a VFS. The FEES is portable, repeated assessment is safe, laryngeal closure patterns are more observable, and it can be used as a biofeedback tool for teaching airway protection strategies (Groher & Crary, 2003; Logemann, 1998).

An example of a fibreoptic endoscopic evaluation of swallowing.


Groher, M., & Crary, M. (2003). Introduction to adult swallowing disorders. Philadelphia, PA: Butterworth-Heinemann.

Groher, M., & Crary, M. (2010). Dysphagia: Clinical management in adults and children. Maryland Heights, MO: Mosby Elsevier.

Langmore, S., & McCulloch, T. (1997). Examination of the pharynx and larynx and endoscopic examination of pharyngeal swallowing. In A. Perlman & K. Schulze-Derieu (Eds.), Deglutition and its disorders: Anatomy, physiology, clinical diagnosis, and management (pp. 201-226). San Diego, CA: Singular Publishing Group.

Logemann, J. (1998). Evaluation and treatment of swallowing disorders. Austin, TX: Pro-Ed.