Resources

Commonwealth Swallowing Diagnostics strives to support our customers and their patients by providing a variety of resources related to FEES.

Scroll down to find informational handouts, helpful links, and relevant research citations. Check back soon to find links to our blog, socials, recorded webinars, and more to come!

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Close-up of a mouth with white teeth and pink lips, holding two pills, one green and one yellow.
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Informational Handouts

Patients: What to Expect
Admin: Cost-Saving Info
Scheduling: Start to Finish
Imaging Decision Diagram
FEES: Who Can Benefit
FEES: What Can It Show
A healthcare worker checks an elder woman's throat while she swallows liquids seated in a wheelchair, in a bright care facility.

Helpful Links

Dysphagia Cost

Studies show dysphagia significantly increases healthcare costs, adding roughly 30% to 40% more to inpatient hospital expenses per admission. Dysphagia extends hospital stays by an average of 2 to 4 days and can lead to costly complications like aspiration pneumonia, averaging around $17,000 per episode of care.

Close-up of two people holding hands, one elderly and one younger, inside a room with wooden flooring.

  • Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Serv Res. 2018;18(1):594. Published 2018 Aug 2. doi:10.1186/s12913-018-3376-3

  • Bonilha HS, Simpson AN, Ellis C, Mauldin P, Martin-Harris B, Simpson K. The one-year attributable cost of post-stroke dysphagia. Dysphagia. 2014;29(5):545-552. doi:10.1007/s00455-014-9543-8

  • Hwang D, Teno JM, Gozalo P, Mitchell S. Feeding tubes and health costs postinsertion in nursing home residents with advanced dementia. J Pain Symptom Manage. 2014;47(6):1116-1120. doi:10.1016/j.jpainsymman.2013.08.007

  • Westmark S, Melgaard D, Rethmeier LO, Ehlers LH. The cost of dysphagia in geriatric patients. Clinicoecon Outcomes Res. 2018;10:321-326. Published 2018 Jun 6. doi:10.2147/CEOR.S165713

  • Cichero JA, Altman KW. Definition, prevalence and burden of oropharyngeal dysphagia: a serious problem among older adults worldwide and the impact on prognosis and hospital resources. Nestle Nutr Inst Workshop Ser. 2012;72:1-11. doi:10.1159/000339974

  • Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia. 2002; 10.1007/s00455-002-0072-1

Value of FEES Imaging

Studies show that FEES exams completed in the post-acute care setting demonstrate significant improvement in diet levels, lower rates of pneumonia, and improved outcomes measures.

Three older adults around a table, laughing and enjoying a meal together in a bright, sunny room with large window views of greenery.

  • Hopkins-Rossabi T, Lenze A, Lindler SC, Hardy C, Temple SL. Analysis of Patients' Dietary Status/Restrictions Following Instrumental Swallow Evaluations in Skilled Nursing Facilities. Dysphagia. Apr 2025;40(2):476–488. doi:10.1007/s00455-024-10750-x

  • Hopkins A, Vollman C, Boyce S, Krekeler BN. Accessing Swallow Imaging Evaluations in the Community: A Cross-Sectional Survey of Speech-Language Pathologists. Perspectives of the ASHA Special Interest Groups. 2026;11(3):934–946. doi:10.1044/2025_persp-25-00173

  • Bice EM, Galek KE, Ward M. Dysphagia and Diets in Skilled Nursing Facilities When Patient's Health Status Changes: The Role of Imaging. J Am Med Dir Assoc. 2024;25(2):381-386. doi:10.1016/j.jamda.2023.11.008

  • Pekacka-Egli AM, Kazmierski R, Lutz D, et al. Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions. J Clin Med. 2021;10(8):1714. Published 2021 Apr 15. doi:10.3390/jcm10081714

  • Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia. 2017;32(1):27-38. doi:10.1007/s00455-016-9775-x

Importance of Instrumentals

The direct visualization of anatomy and physiology during FEES allows for assessment of tissue and muscle function, anatomical variants and abnormalities, and provides insight into the true etiology for dysphagia.

A person projecting a light onto a mirror, showing a reflection of their face through the dotted pattern of a circular object.

  • Leder SB. Comparing Simultaneous Clinical Swallow Evaluations and Fiberoptic Endoscopic Evaluations of Swallowing: Findings and Consequences. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 2015; ASHA Volume 24.

  • Bours GJ, Speyer R, Lemmens J, Limburg M, de Wit R. Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review. J Adv Nurs. 2009;65(3):477-493. doi:10.1111/j.1365-2648.2008.04915.x

  • Leder SB, Espinosa JF. Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia. 2002;17(3):214-218. doi:10.1007/s00455-002-0054-7

  • Lim SH, Lieu PK, Phua SY, et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia. 2001;16(1):1-6. doi:10.1007/s004550000038

  • Miles A, McFarlane M, Scott S, Hunting A. Cough response to aspiration in thin and thick fluids during FEES in hospitalized inpatients. Int J Lang Commun Disord. 2018;53(5):909-918. doi:10.1111/1460-6984.12401

  • Pazak J, Bhatt NK, Levy A, Schick S, O'Dell K. Incidental Laryngeal Findings on Bedside Flexible Endoscopic Evaluation of Swallowing in a Community Hospital Setting. Ann Otol Rhinol Laryngol. 2021;130(8):881-884. doi:10.1177/0003489420987201

Comfort and Safety of FEES

FEES has proven to be a safe and well tolerated method of assessing swallow function when performed by a trained Speech Pathologist. The rate of complications associated with FEES is less than 1% overall.

Group of four doctors and healthcare professionals sitting during a meeting in a bright room with large windows, listening attentively.

  • ‍Dziewas R, Auf dem Brinke M, Birkmann U, et al. Safety and clinical impact of FEES - results of the FEES-registry. Neurol Res Pract. 2019;1:16. Published 2019 Apr 26. doi:10.1186/s42466-019-0021-5

  • Warnecke T, Teismann I, Oelenberg S, et al. The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke. 2009;40(2):482-486. doi:10.1161/STROKEAHA.108.520775

  • Aviv JE, Murry T, Zschommler A, Cohen M, Gartner C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations. Ann Otol Rhinol Laryngol. 2005;114(3):173-176. doi:10.1177/000348940511400301

  • O'Dea MB, Langmore SE, Krisciunas GP, et al. Effect of Lidocaine on Swallowing During FEES in Patients With Dysphagia. Ann Otol Rhinol Laryngol. 2015;124(7):537-544. doi:10.1177/0003489415570935

  • Kamarunas EE, McCullough GH, Guidry TJ, Mennemeier M, Schluterman K. Effects of topical nasal anesthetic on fiberoptic endoscopic examination of swallowing with sensory testing (FEESST). Dysphagia. 2014;29(1):33-43. doi:10.1007/s00455-013-9473-x

  • Fife TA, Butler SG, Langmore SE, et al. Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients. Ann Otol Rhinol Laryngol. 2015;124(3):206-211. doi:10.1177/0003489414550153

  • Lester S, Langmore SE, Lintzenich CR, et al. The effects of topical anesthetic on swallowing during nasoendoscopy. Laryngoscope. 2013;123(7):1704-1708. doi:10.1002/lary.23899

FEES and MBSS

Studies show there is a good agreement between MBSS and FEES when examining premature spillage, pharyngeal residue, laryngeal penetration, and tracheal aspiration. FEES has proven to be as sensitive, or more sensitive, than MBSS relative to standard swallowing parameters.

  • Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, et al. Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope. 2017;127(9):2002-2010. doi:10.1002/lary.26419

  • Pisegna JM, Langmore SE. Parameters of Instrumental Swallowing Evaluations: Describing a Diagnostic Dilemma. Dysphagia. 2016;31(3):462-472. doi:10.1007/s00455-016-9700-3

  • Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare?. Laryngoscope. 2007;117(10):1723-1727. doi:10.1097/MLG.0b013e318123ee6a

  • Rao N, Brady SL, Chaudhuri G, Donselli JJ, & Wesling MW. Gold-standard? Analysis of the videofluoroscopic and fiberoptic endoscopic swallow examinations. Journal of Applied Research. 2003; 3(1), 89-96.