Current research supports that both FEES and MBSS are valuable procedures for evaluating dysphagia and can both be considered ‘Gold Standards.’ The choice of which instrumental assessment to use should be dictated by clinical indications, equipment availability, and clinical expertise of the evaluators. It is also important to understand the strengths and limitations of each diagnostic procedure.

FEES MBSS
Stage of swallowing assessed Pharyngeal stage before, during and after the swallow. Inferences are made about the oral and esophageal (reflux) stages. Primarily from the superior view. Oral, pharyngeal, and cervical esophageal stages. Primarily from the lateral view.
Where can it be performed? Any location. Hospital, SNF, OP clinic, patient’s home, at bedside, in wheelchair, etc. Hospital radiology suite, mobile radiology van.Occasionally at bedside with portable C-Arm
Contraindications Very few. Severe craniofacial trauma, highly agitated/confused patients Patients unable to leave bed or unable to transfer to fluoro suite. Unable to position upright, allergic or
sensitive to barium, medically unstable, or highly agitated/confused.
Limitations of examination May miss penetration/aspiration during brief moment of ‘white out.’Does not directly observe oral and esophageal phases Fluoro turned on/off with each swallow, leading to missed behaviors immediately before or after the swallow. Unable to directly visualize laryngeal anatomy. Barium mixed with food can change viscosity
Bonus features Secondary assessment of velopharyngeal closure and laryngeal/pharyngeal surfaces and functions Screening of esophagus during swallow

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Specific Benefits of FEES:

  • Higher sensitivity to pharyngeal residue vs. MBSS
  • No radiation exposure
  • No need to transport medically complex patients to radiology
  • FEES are easily performed on bariatric patients and medically fragile patients
  • FEES can be performed at bedside in a wide variety of positions
  • FEES can be utilized on patients on mechanical ventilation
  • A physician does not have to be present during FEES
  • FEES are recorded and displayed in color
  • Direct visualization of laryngeal and pharyngeal anatomy allows for observation of clinically significant findings including but not limited to: vocal fold immobility/hypomobility, excessive secretions/ aspiration of secretions, vocal fold polyps, nodules, etc., erythema of tissue/mucosa.
  • No ingestion of barium. Only normal food is given during FEES