FEES vs MBSS
Current research supports that both FEES and MBSS are valuable procedures for evaluating dysphagia and can both be considered ‘Gold Standards.’ The choice of which instrumental assessment to use should be dictated by clinical indications, equipment availability, and clinical expertise of the evaluators. It is also important to understand the strengths and limitations of each diagnostic procedure.
| FEES | MBSS | |
|---|---|---|
| Stage of swallowing assessed | Pharyngeal stage before, during and after the swallow. Inferences are made about the oral and esophageal (reflux) stages. Primarily from the superior view | Oral, pharyngeal, and cervical esophageal stages. Primarily from the lateral view |
| Where can it be performed? | Any location. Hospitals, rehabilitation facilities, patient’s home, physicians’ office, at bedside, in a wheelchair | Hospital radiology suite, mobile fluoroscopy van, or in large area through use of portable C-arm fluoroscopy |
| Contraindications | Minimal. Severe craniofacial anomalies/trauma, highly agitated and confused patients, persistent epistaxis | Patients unable to leave bed or unable to transfer to fluoro suite. Unable to position upright, allergic or sensitive to barium, medically unstable, or highly agitated/confused |
| Limitations | May miss penetration/aspiration during brief moment of ‘white out.’ Does not directly observe oral and esophageal phases | Fluoro turned on/off with each swallow, leading to missed behaviors immediately before or after the swallow. Unable to directly visualize laryngeal anatomy, soft tissue, mucosa quality. Barium mixed with food can change viscosity. Limitation of foods/liquids provided. Restricted duration of exam and repeatability due to radiation exposure. |
| Physician presence required | No | Yes |
| Additional features | Assessment of velopharyngeal closure, laryngeal/pharyngeal structures, functions and surfaces. Biofeedback during evaluation while performing compensatory behaviors and exercises | Screening of esophagus during swallow |