In speech-language pathology, accurate assessment tools are essential for effective diagnosis and treatment. The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) procedure has become a cornerstone in dysphagia management, providing clinicians with direct visualization of swallowing function. At NewCura, we understand how technology integration can enhance this vital diagnostic tool, which is why our EndoManager® Imaging system is designed to work seamlessly with FEES procedures.

Understanding the FEES Procedure

FEES is a well-established technique that involves passing a flexible endoscope through a patient’s nasal passage to obtain a superior view of the pharynx, larynx, and upper esophageal opening. This direct visualization allows speech-language pathologists (SLPs) to assess swallowing function in real time.

The procedure typically consists of two phases:

1. Initial Assessment: The SLP examines the structure of the pharynx and larynx, observing how well the patient swallows saliva.
2. Dynamic Evaluation: The patient consumes various textures and sizes of food and liquid, often colored with food dye for better visibility. This helps the SLP evaluate the swallowing mechanism with different consistencies.

FEES is particularly valuable for patients with dysphagia (difficulty swallowing), which can lead to aspiration—when food or liquid enters the airway instead of the esophagus. If left unaddressed, aspiration can cause serious complications like pneumonia.

Clinical Benefits of FEES

The FEES procedure offers numerous advantages that make it an indispensable tool in dysphagia management:

• Point-of-Care Assessment: FEES can be performed at bedside in acute care, skilled nursing facilities, outpatient clinics, or even in a patient’s home, eliminating transportation challenges for medically fragile individuals.
• Patient Comfort and Positioning: Patients can be evaluated in their natural eating positions—whether sitting upright, reclining, or even in a hospital bed—providing a more realistic assessment of their daily swallowing function.
• Medically Complex Patients: FEES is particularly valuable for patients who cannot be easily transported for other imaging studies, including those who are ventilator-dependent, have tracheostomies, or are hemodynamically unstable.
• Extended Evaluation Time: Unlike some other assessment methods, FEES has no time constraints or radiation exposure limits, allowing clinicians to observe the effects of fatigue on swallowing function during longer meals.
• Real-Time Therapeutic Intervention: SLPs can immediately test compensatory strategies, positioning changes, or swallowing maneuvers during the procedure, assessing their effectiveness on the spot.
• Variety of Food Consistencies: The procedure accommodates testing with a wide range of food textures and liquids, from thin liquids to solid foods, providing comprehensive information about diet tolerances.
• Patient and Caregiver Education: The visual nature of FEES offers powerful educational opportunities, as patients and family members can observe swallowing difficulties directly, potentially improving compliance with recommendations.

Imaging Technology and FEES

The integration of advanced imaging technology with FEES procedures represents a significant advancement in swallowing assessment. High-quality imaging enhances several aspects of the clinical process:

• Anatomical and Physiological Visualization: Modern imaging systems provide exceptional clarity of pharyngeal and laryngeal structures, allowing clinicians to identify subtle abnormalities such as edema, structural asymmetries, or tissue changes that may impact swallowing.
• Documentation of Dynamic Events: Swallowing is a rapid, complex process that occurs in milliseconds. Advanced imaging captures these fleeting events—including critical moments such as epiglottic inversion, laryngeal vestibule closure, and pharyngeal constriction—allowing for frame-by-frame analysis after the procedure.
• Objective Measurement: Digital imaging enables objective measurement of timing, residue amounts, and airway protection events, moving beyond subjective impressions toward quantifiable assessment parameters.
• Sequential Comparison: Storing high-quality images and videos allows clinicians to compare findings across multiple sessions, objectively documenting improvement or decline in swallowing function over time or following intervention.
• Interdisciplinary Communication: Comprehensive visual documentation enhances communication between SLPs and other healthcare providers, including otolaryngologists, gastroenterologists, neurologists, and radiation oncologists who may contribute to dysphagia management.
• Evidence-Based Practice: Detailed imaging contributes to research and quality improvement initiatives by providing standardized documentation that can be analyzed across patient populations.
• Clinical Training: Recorded assessments serve as valuable educational tools for training new clinicians in the nuances of swallowing assessment and the spectrum of normal versus pathological findings.

EndoManager® and FEES: A Complementary Approach

When conducting FEES procedures, having the right imaging tools is essential for accurate diagnosis and documentation. EndoManager® Imaging works alongside the FEES procedure by:

• Supporting the Full Procedure: The system accommodates the complete FEES workflow, from initial assessment to dynamic evaluation with various food consistencies
• Capturing Important Details: High-definition imaging ensures that subtle signs of dysphagia, such as residue in the pharyngeal recesses or trace aspiration, are clearly documented
• Providing Streamlined Documentation: The integration capabilities allow findings to be easily incorporated into the patient’s medical record
• Enhancing Clinical Collaboration: Recorded assessments can be reviewed by the entire care team, improving interprofessional communication

NewCura’s EndoManager® Imaging system enhances the FEES procedure by providing speech pathologists with dedicated technology support for this specialized assessment:

• Compatible Equipment Integration: The vendor-neutral design works with various endoscopic systems used in speech pathology departments, enabling facilities to utilize existing FEES equipment while adding digital documentation capabilities
• Enhanced Clinical Documentation: High-definition image and video capture helps SLPs document the subtle findings that inform dysphagia treatment planning, such as trace aspiration or pharyngeal residue
• Workflow Efficiency: Features like one-click exam start simplify the technical aspects of FEES procedures, allowing speech pathologists to focus on patient assessment rather than managing complex technology
• Seamless Medical Record Integration: Integration with facility EMR/EHR systems ensures that valuable FEES findings become part of the patient’s permanent medical record, accessible to the entire care team
• Multi-Input Support: Some FEES assessments benefit from multiple viewing angles or supplementary imaging. EndoManager®’s ability to accommodate various inputs supports comprehensive evaluation when clinically indicated

By addressing these practical aspects of FEES procedures, EndoManager® helps speech-language pathologists conduct thorough swallowing assessments with reduced technical burden, supporting the critical work of dysphagia management and rehabilitation.

Practical Applications in Speech Pathology

SLPs who incorporate integrated technology with FEES procedures benefit from several enhanced clinical capabilities.

Detailed imaging allows for precise analysis of swallowing physiology, helping clinicians identify specific aspects of dysfunction. This leads to more targeted treatment planning and intervention. Additionally, recorded assessments serve as valuable educational tools—both for patient education and for training new clinicians in swallowing assessment techniques.

Looking Forward

As dysphagia assessment continues to evolve, the integration of specialized imaging software with procedures like FEES represents an important advancement in clinical practice. At NewCura, we’re committed to supporting speech pathologists with compatible technology that enhances their existing diagnostic capabilities. By ensuring that our EndoManager® Imaging system works harmoniously with the FEES procedure, we aim to contribute to improved patient outcomes through accurate assessment and documentation.