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Purpose: Fiberoptic endoscopic evaluation of swallowing (FEES) is a widely used instrumental procedure used to assess swallowing function in persons of all ages, from infants to older adults. In this article, the history of FEES in adults, the protocol, the scoring system, and the interpretation of abnormal findings are summarized. The use of FEES to guide treatment in adults is also covered briefly. Following this review in adults, the use of FEES in infants and children is presented, including the anatomicalphysiological assessment and the assessment of swallowing of food and liquid. Interpretation of findings and therapeutic applications are discussed.
Conclusion: FEES is a valuable part of the clinical protocol for evaluation and management of dysphagia across the life span. It provides a mechanism for in-depth analysis of swallowing structures and function during intake of liquid and food boluses. Future developments include standardized training content to ensure clinical competency and the development of standardized examination and interpretation protocols.
The first article describing fiberoptic endoscopic evaluation of swallowing (FEES) in adults was published in 1988 by Langmore et al. (1988). It proposed a new procedure to use with patients who needed an instrumental examination but for whom it would be difficult to perform videofluoroscopy. These were patients who were bedbound and difficult to move, patients in the intensive care unit, and patients who needed an examination earlier than could be scheduled in radiology. Over the years, as the technology supporting FEES has advanced and the protocol and scoring systems have become more sophisticated, it has become evident that FEES is another gold standard, along with the fluoroscopic procedure and manometry (Dziewas et al., 2019, 2017, 2016; Knigge et al., 2014; Langmore, 2017). It is useful for a wide range of patients in many settings and can reveal the nature and severity of the dysphagia as well as guide treatment. The use of FEES in the western world has grown exponentially. Interestingly, the adoption of FEES in newly developing countries, where dysphagia care is just emerging, is impressive. Reasons for this include the fact that otolaryngologists or phoniatricians sometimes take the lead in evaluating dysphagia, and they have the equipment at hand. Another major reason is the lower cost for acquiring FEES systems and the space needed...