Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a diagnostic procedure used to assess and visualize the swallowing process. This technique involves the insertion of a flexible endoscope through the nose to allow direct observation of the pharynx and larynx during swallowing. FEES is particularly useful for identifying abnormalities in swallowing mechanics, especially in individuals with conditions such as
cancer.
Cancer, particularly head and neck cancers, can significantly impact swallowing function. Tumors, surgical interventions, and treatments like
radiation therapy and
chemotherapy can cause structural and functional changes in the swallowing mechanism. FEES helps in early detection of dysphagia (swallowing difficulties), allowing for timely interventions that can improve the patient's quality of life and prevent complications such as
aspiration pneumonia.
The procedure is typically performed by a speech-language pathologist (SLP) or an otolaryngologist. The patient is seated comfortably, and a topical anesthetic may be applied to the nasal passage. The endoscope is then gently inserted through the nose and positioned to allow a clear view of the pharynx and larynx. The patient is asked to perform a series of swallowing tasks with different consistencies of food and liquids. The real-time visualization helps in assessing the coordination, timing, and safety of swallowing.
FEES can identify a range of swallowing disorders, including:
Pharyngeal dysphagia: Difficulty in the pharyngeal phase of swallowing.
Laryngeal penetration: When food or liquid enters the larynx but does not pass below the vocal cords.
Aspiration: When food or liquid passes below the vocal cords into the trachea.
Residue: Leftover food or liquid in the pharynx after swallowing.
Structural abnormalities: Tumors, strictures, or other anomalies affecting swallowing.
FEES offers several advantages:
Direct visualization: It provides a direct view of the pharynx and larynx, allowing for detailed assessment of anatomical and functional abnormalities.
Real-time assessment: Swallowing can be observed in real-time, providing immediate feedback.
Minimal invasiveness: The procedure is less invasive compared to other techniques like videofluoroscopic swallow study (VFSS).
Portable: FEES equipment is portable, making it suitable for bedside evaluations, especially for medically compromised patients.
FEES is generally considered safe, but like any medical procedure, it carries some risks. Potential risks include:
Nasal discomfort or bleeding.
Gagging or vomiting.
Vasovagal response, leading to fainting in rare cases.
Minor risk of aspiration during the procedure.
These risks are minimal and can be managed effectively by trained professionals.
The findings from FEES can guide individualized treatment plans for cancer patients. Based on the results, interventions may include:
Dietary modifications: Adjusting food textures and liquid consistencies to improve safety and efficiency of swallowing.
Swallowing exercises: Specific exercises to strengthen muscles involved in swallowing.
Compensatory strategies: Techniques such as chin tuck or head turn to facilitate safer swallowing.
Medical or surgical interventions: Addressing underlying structural abnormalities or complications caused by cancer or its treatment.
Conclusion
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a valuable tool in the assessment and management of swallowing disorders in cancer patients. Its ability to provide real-time, direct visualization of the swallowing process makes it indispensable for diagnosing and treating dysphagia. By identifying the specific challenges faced by cancer patients, FEES enables healthcare providers to tailor interventions that can significantly enhance the patient's quality of life and reduce the risk of complications.
