Clinical and Research Updates
Ongoing projects, task forces, research initiatives:
There is a task force organized by the American Board of Swallowing and Swallowing Disorders working to establish FEES practice guidelines. The current ones from ASHA are outdated. Another task force organized by California Speech-Language Hearing Association has developed new wording for the California state regulations that address FEES, with the hope that the state legislature will adopt this wording and make it clear that SLPs can perform FEES without a physician present.
A research initiative, organized by Drs. Kate Hutcheson and Heather Starmer is in progress. Its goal is to develop a FEES-DIGEST scoring system.
Readings:
Here are links to 5 recent articles either about FEES or ones that use FEES to evaluate patients. The last article contains some very practical information for FEES users.
- Aspiration after Congenital Surgery
Raulston, J.E.B., Smood, B., Moellinger, A. et al. Pediatr Cardiol (2019) 40: 1296. https://doi.org/10.1007/s00246-019-02153-9. PubMed PMID: 31342114 - Aspiration in the Fiberoptic Endoscopic Evaluation of Swallowing Associated with an Increased Risk of Mortality in a Cohort of Patients suspected of Oropharyngeal Dysphagia
Giraldo-Cadavid, L.F., Pantoja, J.A., Forero, Y.J. et al. Dysphagia (2019). https://doi.org/10.1007/s00455-019-10036-7. PubMed PMID: 31327077 - Fiberoptic Endoscopic Evaluation of Swallow in Intensive Care Unit Patients Post Extubation
Ambika, R. S., Badari Datta, B. V. Manjula, Unmesh V. Warawantkar, and Anita Mariet Thomas. “Fiberoptic Endoscopic Evaluation of Swallow (FEES) in Intensive Care Unit Patients Post Extubation.” Indian Journal of Otolaryngology and Head & Neck Surgery 71, no. 2 (2019): 266-270. PubMed PMID: 31275842; PubMed Central PMCID: PMC6582097. - Assessment of the Reliability of FEES as an Outcome Measure in Patients Undergoing Revision Anterior Cervical Discectomy and Fusion
Erwood MS, Walters BC, Connolly TM, Carroll WR, Trahan DV, Graves AW, Agee BS, Hadley MN. Assessment of the Reliability of the Fiberoptic Endoscopic Evaluation of Swallowing as an Outcome Measure in Patients Undergoing Revision Anterior Cervical Discectomy and Fusion. World Neurosurg. 2019 Jun 14. pii: S1878-8750(19)31568-2. doi: 10.1016/j.wneu.2019.06.028. PubMed PMID: 31203083.
- Detection of Airway Invasion During Flexible Endoscopic Evaluations of Swallowing: Comparing Barium, Blue Dye, and Green Dye. Curtis J, Perry S, Troche MS. Detection of Airway Invasion During Flexible Endoscopic Evaluations of Swallowing: Comparing Barium, Blue Dye, and Green Dye. Am J Speech Lang Pathol. 2019 May 27;28(2):515-520. doi:10.1044/2018_AJSLP-18-0119. Epub 2019 Feb 18. PubMed PMID: 31136233.
Publications & Milestones
First publication: Langmore, Schatz, and Olson, Dysphagia, 1988.
FEES was first developed in response to a need for a more portable exam to replace the bedside clinical exam for inpatients. As its value as a stand-alone exam became better appreciated and as technology advanced, FEES has evolved to the point where today FEES is a standard instrumental exam that is widely done throughout the US and internationally.
FEES included in the SLP scope of practice by ASHA, 1991.
By identifying FEES as an evaluation procedure that is within the scope of practice of SLPs, ASHA established its credibility. They emphasized that training is needed to perform and interpret the exam and followed this document with a Position Statement on the role of the SLP and further documents that provided Knowledge and Skills needed to perform the exam. The ASHA website has these documents available to anyone.
FEES made a billable CPT procedures, 1994 (CPT – 92612)
In 1994, The Centers for Medicare and Medicaid Services determined that FEES should have its own CPT code, thus establishing it as a procedure that is separate and distinct from other procedures that utilize a laryngoscope. From that time on, FEES was no longer confused with CPT code # 31575, Diagnostic Laryngoscopy, as typically performed by otolaryngologists as their standard laryngoscopy exam to assess for laryngeal pathology.
Textbook on FEES published 2001.
A good resource for learning more about FEES is my textbook:Langmore, Susan E. Fiberoptic Endoscopic Evaluation and Treatment of Swallowing Disorders. Thieme Medical Publishers, 2001.
