Speech Language Patholgists (SLPs)

Why FEES?

As Speech Language Pathologists, we utilize our visual, auditory and tactile senses to determine a patient’s swallowing function. Unfortunately, various disease processes and injuries place limitations on our skilled senses. FEES allow for the internal view of the swallowing ability that our non-x ray eyes lack. It also allows for the detection of the silent aspiration that our ears can’t hear, as well as identifying the lack of peristaltic motion that our touch can’t palpate.

Let us come to you and assist you in seeing the full picture of your patient’s swallow. We come to you, allowing the patient to be assessed in a natural setting, minimizing downtime, and allowing for immediate answers. We bring different textures to trial, but if you have key foods, drinks, or medications that you want your patient tested with we can accommodate. You will be provided with a report and pertinent pictures at the end of the evaluation.

There are a few guidelines to keep in mind:

  • We have to have a contract with your facility. If we don’t, please contact us
  • You cannot do a Bedside Swallow Evaluation (92610) on the same day as the FEES (92612).
  • We would prefer you to be present during the FEES. You know the patient best. We are there to help you determine the best plan of care for your patient.
  • Family can definitely be present during the FEES. We find that explaining the FEES as we go along allows families to better comprehend what is going on with their loved one’s swallowing.
  • You can bill for any dysphagia therapy (92526) you do that day.

Physicians

Why Safe Swallow AZ, PLLC for FEES?

Safe Swallow AZ, PLLC is a mobile FEES service. By contracting with us, you will be able to offer an instrumental dysphagia assessment in your own office or clinic. If you have patients in Skilled Nursing Facilities, Assisted Living Facilities, or Hospital settings that do not have FEES capabilities, we will gladly introduce ourselves to them. Our goal is to provide timely, quality diagnosis of swallowing deficits. As SLPs we realize our limitations of bedside swallow evaluations. FEES provide us with the bird’s-eye view of the swallow mechanism at rest as well as during the act of swallowing. We provide a written report as well as any pertinent pictures at the end of the evaluation.

To find out more about FEES, the in-office process, or how to have FEES become part of you clinical service repertoire, contact us.

Facilities

Why instrumental swallow studies?

Silent aspiration and alternative diet textures lead to patients’ decline in health and decreased family and patient dissatisfaction, not to mention cost facilities thousands of dollars every year. Speech Language Pathologist are skilled in recognizing swallowing problems; however, they don’t have x-ray vision. This is where instrumental assessments come into play. There are 2 types of instrumental swallow studies: Modified Barium Swallow Studies (MBSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

MBSS vs FEES

The MBSS, also known as video-fluoroscopic swallow study, is a motion picture X-ray of the swallowing process. MBSS was considered the Gold Standard in instrumental swallowing evaluation. It is non-invasive and gives a dynamic view of the oral, pharyngeal and esophageal phases of swallowing. It is performed in either the Radiology Department at a hospital or in a mobile van. The procedure involves the Radiologist, Radiology Technologist and Speech-Language Pathologist. The patient needs to be able to sit upright is a confined space and is given different consistencies of barium, while being x-rayed.

The limitations of the MBSS include:

  • Limited “on time” to minimize radiation exposure
  • Body habitus
  • Use of barium products to resemble food textures
  • Patient fatigue for your more medically compromised patients
  • Cost (2 to 3 times the cost of FEES)

FEES utilize a thin fiberoptic scope that is passed through the nares by a trained Speech Language Pathologist and rests behind the velum in the back of the throat. The view on the screen gives a bird’s-eye view of the swallowing mechanism at rest as well as during the act of swallowing. FEES can be mobile and brought directly to your residents. The resident does not require transportation to a van or hospital, reducing downtime and fatigue and allowing the patient to maximize therapy time for the day. The resident can be tested with actual food (not barium products) and even with scheduled medication if this is an area of difficulty.

FEES can be performed with residents who have:

  • Isolation restrictions
  • Ventilators/tracheostomies
  • Positioning restrictions
  • Large body habitus

The FEES on-screen viewing allows for the resident’s primary Speech-Language Pathologist to collaborate in real-time on their resident’s plan of care as well as allow families to be educated real-time on their loved one’s swallowing abilities.

FEES limitations are with residents who have:

  • A history of severe bleeding condition or severe nose bleeds (epistaxis)
  • Recent facial fractures near the nasal area
  • Bilaterally obstructed nasal passages
  • Severe agitation
  • Recent history of vasovagal reactions

Studies have shown that both instrumental studies, while each has their own limitations, can be considered the Gold Standard. Both MBSS and FEES are available to your residents. FEES is cost effective and allows a more realistic timely overview of what is going on with your residents’ swallowing.

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