92616 Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording

Name of the Procedure:

Flexible Endoscopic Evaluation of Swallowing and Laryngeal Sensory Testing (FEES)

Summary

Flexible Endoscopic Evaluation of Swallowing (FEES) is a diagnostic procedure used to assess swallowing function and test the sensory capacity of the larynx. During the procedure, a thin, flexible tube with a camera (endoscope) is passed through the nose to visualize the throat and larynx while the patient swallows different foods or liquids. This helps identify swallowing disorders and sensory deficits that might cause issues.

Purpose

• Medical Condition: Dysphagia (difficulty swallowing), aspiration risk, laryngeal sensory deficits.
• Goals: Assess swallowing mechanics, identify the presence of aspiration (food or liquid entering the airway), and evaluate the sensory response to help guide treatment and dietary modifications.

Indications

• Symptoms like coughing or choking during meals, recurrent pneumonia, unexplained weight loss, voice changes, or suspect laryngeal sensory deficits.
• Patients with neurological conditions, head and neck surgery, or radiation therapy affecting swallowing.

Preparation

• Fasting: Typically, patients should fast for a few hours before the procedure.
• Medication Adjustments: Some medications should be withheld; this will be advised by the healthcare provider.
• Diagnostic Tests: A clinical swallowing assessment may be performed prior to FEES.

Procedure Description

1. The patient sits upright.
2. A numbing agent may be applied to the nasal passages.
3. The clinician inserts the flexible endoscope through one nostril to visualize the pharynx and larynx.
4. The patient is asked to swallow various textures and consistencies of food or liquid.
5. Cine or video recording is done to review the anatomy and function in detail.
6. Sensory testing involves stimulating the larynx and noting the reflexive response.

Duration

The procedure typically takes about 20-30 minutes.

Setting

FEES is performed in an outpatient clinic, hospital, or a specialized swallowing center.

Personnel

• Conducted by a speech-language pathologist or an otolaryngologist.
• Assisted by nurses or other trained professionals.

Risks and Complications

• Common Risks: Discomfort or gagging, minor nosebleed, slight nasal or throat irritation.
• Rare Risks: Vasovagal response (fainting), airway compromise, allergic reaction to numbing agents.

Benefits

• Expected Benefits: Accurate assessment of swallowing function and laryngeal sensory capacity.
• Timing of Benefits: Results are immediate and can be discussed right after the procedure.

Recovery

• Post-procedure care involves monitoring for any signs of nasal or throat irritation.
• Most patients can resume normal activities immediately.
• Follow-up appointments may be scheduled based on the results.

Alternatives

• Videofluoroscopic Swallow Study (VFSS): Another method to evaluate swallowing function using X-ray.
• Pros and Cons:
  • FEES: No radiation exposure, excellent visualization of laryngeal structures, but may be uncomfortable.
  • VFSS: Provides comprehensive esophageal phase evaluation but requires radiation exposure.

Patient Experience

• During the Procedure: Mild discomfort, a sensation of pressure or minor gagging, and the presence of the endoscope in the nasal passage.
• Post-Procedure: Minimal pain or discomfort managed with over-the-counter pain relievers if needed. Most patients feel normal shortly after the procedure.