Nasendoscopy: A Speech Pathologist’s Perspective on Flexible Endoscopic Evaluation of Swallowing (FEES)

A key role I play at Errard Specialists, Ballarat is to diagnose and manage swallowing disorders. One of the most effective tools we use for this purpose is nasendoscopy, known as Flexible Endoscopic Evaluation of Swallowing (FEES).

This procedure allows me to closely examine the anatomy and physiology of a patient’s swallowing mechanism.

Understanding Patient Concerns

When I first discuss FEES with a patient, I often encounter a mix of anxiety and curiosity. Patients worry about the discomfort of having a scope inserted through their nose, the possibility of gagging, and the overall safety of the procedure. Addressing these concerns is a crucial part of my job. I reassure them that while the sensation is unusual, it is typically not painful, and the procedure is safe and well-tolerated by most people.

Pre-Procedure Preparation

No preparation is required for the procedure! Have brekky, lunch, a snack!

I do prefer you to bring someone along with you - a family member, carer or just a friend. It’s always good to have a second set of ears, but they can also help out during the procedure as well. If you come alone, not a problem - I record each procedure and go over it with you.

Conducting the Procedure

I gently insert the thin, flexible endoscope through one of your nostrils - did you know that it varies throughout the day, which nasal passage may be more open than the other!? This part can feel strange, but I’ll guide you through it.

Once the scope is in place, I’ll ask you to perform various swallowing tasks, such as drinking milk (I can see milk better on the screen), swallowing food or speaking. These tasks help me observe the different phases of swallowing or the muscles involved for speaking/breathing in real time. The endoscope transmits live video footage to my monitor, allowing us both to see the process. The visual feedback is not only fascinating but also educational.

Analysis and Diagnosis

As I watch the monitor, I look for key indicators of swallowing difficulties, such as food residue in the throat, penetration or aspiration (when food or liquid enters the airway), and delayed swallowing reflexes. These observations are critical for diagnosing the specific nature and severity of the swallowing disorder or, if any breathing or voice use patterns may be able to be addressed in therapy.

After the procedure, we sit down to discuss my findings. This is a collaborative conversation where I explain what I observed and how it relates to symptoms. For example, if I notice that food residue is lingering in the throat, it might indicate muscle weakness or incoordination. At the same time, I may observe additional things that explain sensations in the throat that are causing discomfort.

Developing a Treatment Plan

Based on the assessment, I develop a personalised treatment plan tailored to the needs. This might include specific swallowing exercises to strengthen muscles, strategies to improve safety during eating and drinking, and dietary modifications to reduce the risk of aspiration. I also schedule follow-up sessions to monitor progress and adjust therapy as needed. The assessment may simply be some piece of mind for both of us, that everything looks normal. Each procedure is reviewed by our ENT, so this is a dual consultation, regardless of normal or abnormal findings.

For more complex cases, I collaborate with other healthcare professionals, including those working directly alongside me, at Errard Specialists and the broader allied health community - my work at the hospital and experience provides a long list of collaborative professionals that I can refer on to.

From a speech pathologist’s perspective, conducting a nasendoscopy for FEES is a necessary and optimal way of understanding someone’s swallowing (or breathing/voice) patterns. It gathers detailed, real-time information about swallowing function, not able to be seen at the bedside/in a clinic. This leads to more accurate diagnoses and effective treatment plans.

While the initial concerns from patients are understandable, the procedure is typically straightforward and minimally invasive, providing significant benefits in understanding and managing swallowing disorders… and, I’ve had it done myself - don’t worry!