Voice/Swallowing/Feeding Department

Pediatric and Adult Services

FEES (Flexible Endoscopic Evaluation of Swallowing)

The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a procedure used by speech-language pathologists to evaluate the pharyngeal stages of swallowing. The portable study uses a flexible fiberoptic laryngoscope whish is passes transnasally to the hypophaynx. The scope hangs above the epiglottis and does not pass between the vocal folds. Patients are seated in a functional feeding position and are offered a variety of food consistencies while the swallow is viewed on a TV monitor. The study is recored and video prints can be left in the medical chart.

The clinician can clearly view laryngeal and pharyngeal structures. The patient is led through various tasks to evaluate the sensory and motor status. Food and liquid are given to the patient so that swallow ability can be determined.

The primary objectives of the FEES are similar to MBS: to assess the pharyngeal stage of swallowing; to detect aspiration; and to determine the safest and least restrictive diet level for the patient.

The major advantages of the FEES compared to MBS are:

• Cost effective
• Portability to bedside
• No radiation
• No Barium which is distasteful to the patient
• Uses actual meal tray items
• Direct viewing of laryngeal functioning for airway protection
• Functional – it stimulates natural every day eating
• Quick testing and results
• Used to train the patient via biofeedback
• Assesses secretions management before risking aspiration of a feeding trial
• Better assessment of neurological status (including sensation)
• More detailed rendering of the anatomy than other methodologies
• Reliable in detecting aspiration
• Strong evaluation tool in the establishment of treatment and compensatory strategies

Information obtained from the FEES examination includes:

• Ability to protect and sustain protection of the airway
• Ability to initiate a prompt swallow
• Timing and direction of movement of the bolus
• Ability to clear the bolus during the swallow
• Presence of pooling and residue of material
• Sensitivity of the pharyngeal/laryngeal structures
• The effect of anatomy on the swallow

Appropriate postural changes and swallowing maneuvers are attempted to detect problems and enable the examiner to make recommendations regarding optimal interventions to improve the safety and efficiency of the swallow, the advisability of oral feeding, and use of appropriate behavioral strategies that facilitate safe and efficient swallowing. The most critical finding is aspiration, and the literature demonstrates that FEES is able to detect this finding with good sensitivity.

Portable FEES Now Available At Your Location! (Hospital, LTC’s)
Call: 956.687.7896
Ask for: Audry Quintanilla M.S. CCC-SLP

Voice Videostroboscopy

This procedure is used to asses vocal fold structure/function. Surrounding muscles and tissue are also examined. Patients are frequently referred for this exam due to hoarse or inadequate vocal quality.
Examples..

• Hoarsness
• Stidor
• Hx of Laryngeal ca/suspicion of laryngeal ca
• Intubation trauma
• Blunt trauma to neck
• Weak voice
• Strained/strangled voice
• Voice changes s/p trach placement of removal
• Aphonia/whisper
• Certain cases of globus/severe lpr
• Pain in the pharynx or odynophagia
• Pre and post videostrobes for any vocal fold surgeries
• Tracheomalacia

Pediatric and Adult MBS (Modified Barium Swallow Studies)
Coming Soon!

VPI Studies (Velopharyngeal Incompetence/Insufficiency)

The study addresses children and adults with hypernasality and speech disturbances due to abnormal articulation and resonance issue associated with:

• Cleft palate or other cranial facial disorders
• Neurological impairments to the nerve of the soft palate impacting resonance
• Flaccid dysarthria patients
• Velocardofacial syndrome(VFCS)
• Foods/liquids escaping out of the nasal passages
• Resonance issues affecting voice quality following nasal based cancer of surgery
• Resonance issues following oral cancer

VitalStim

Swallowing treatment is also available (swallowing exercise combined with electrical stimulation available for adults or pediatric. VitalStim Website

Adult and Pediatric Voice/Swallowing Treatment/G-Tube Weaning

Valley VENT specialize in complex voice and swallowing disorders including syndrome based/cranio-facial disorders and Trach/Vent patients. Individual treatment plans are customized to address a variety of patient voice and swallowing problems. Obtaining optimal voice and swallowing function is our objective.