For the SLP
what you may not know, you don't know

What if I'm happy with the MBSS, isn't it the gold standard?

For a long time in our field, the MBSS was coined the "gold standard" for swallowing assessment.  The reign of the MBSS as the sole and best choice for patients has been haulted by the mountains of research comparing the MBSS and FEES over the last several decades.

FEES has been found to be equal to or greater than the MBSS in detection of penetration, aspiration, bolus spillage, and residue. 

The bottom line is that both the MBSS and FEES are "gold standards" for assessment of swallowing, but with the many patient-centered and clinical advantages of FEES over MBSS, clinicians are embracing FEES across the profession. 

What if my patient won't tolerate FEES?

Patient's tolerate FEES extremely well!  In fact, we've successfully scoped all ranges of patients with various medical diagnosis including: Dementia, Stroke, Parkinson's, Cerebral Palsy, COPD, Anxiety,  etc.

Research has shown repeatedly both the safety and efficacy of use of FEES in the geriatric population.  The fact is, sensation to the scope is reduced in this population and even more so when dysphagia is present.

The best way to appreciate the tolerance of FEES in your patient population is to simply give it a try.  Patients and clinicians both benefit from the use of FEES in all practice settings. 

What if I can't see aspiration during the swallow?

Only 5% of aspiration occurs during the swallow.  On FEES, aspiration that occurs during the swallow or "white out phase" is assessed by viewing the subglottic shelf for aspirated material.  This is visible below the vocal folds because foods and liquids are dyed green for contrast. 

Aspiration that occurs before or after the swallow is visualized directly on FEES. 

What about the esophageal stage? 

Research identifies FEES over MBSS as better able to determine many of the signs and symptoms of esohageal dysphagia.  If a patient has esophageal dysphagia as a main concern, referral to a G.I. doctor should be made where completion of an esophagram or EGD will likely be indicated. 

What if my patient isn't ready for an instrumental evaluation?

Delaying instrumental assessment of swallowing delays patient progress and outcomes.  We must visualize the physiologic impairments, to know what to treat in our patients.  

Research shows that the error rate at the bedside is 70%!  We either over restict patients or miss aspiration all together in the most impaired of patients, all the while impacting patient outcomes and quality of life.   

FEES allows for early assessment, without risk of barium aspiration in the fragile patient, and allows for repeated assessment, without the use of radiation.

What is the benefit of FEES to my facility?

FEES is a lower cost alternative to the MBSS.  There are no radiologists charges, transport charges,  facility charges, or barium fees. 

FEES equipment is portable and testing is done in the patient's room.  This means no time away from the facility or missing important therapies.  The facility SLP may attend the FEES evalulation and bill for treatment immediately following evaluation. 
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