position the patient consistent with the patient’s typical eating posture (e.g., upright, reclined).educate the patient and/or caregiver regarding FEES procedures and rationale for the examination.Clinicians should follow guidelines from their facility and licensing body regarding FEES procedures. Procedures for FEES vary across settings and across clinicians. bilateral obstruction of the nasal passages.history of recent trauma to the nasal cavity or surrounding tissue and structures secondary to surgery or injury.severe bleeding disorders and/or recent severe epistaxis (nosebleed).severe movement disorders that interfere with safe administration.severe agitation and/or inability to cooperate with the examination.In addition to the contraindications for all instrumental evaluations, the following contraindications are specific to FEES: difficulties with obstructed fluoroscopic viewing (e.g., patients wearing a halo, patients wearing a cervical collar).patients’ inability (e.g., patients on ventilators, patients on extracorporeal membrane oxygenation ) to leave the bedside because of mobility and/or postural deficits.concerns or safety issues associated with radiation exposure (e.g., pregnancy).inability to tolerate contrast media (e.g., barium, iohexol) due to allergy or aversion.suspected or observed difficulty with swallowing saliva/oral secretions. directly assess pharyngeal and laryngeal anatomy, and/or.documented pharyngeal dysphagia on a videofluoroscopic swallowing study that can be retested with endoscopy to.need to assess vocal fold dynamics or the laryngeal adductor reflex (LAR) related to swallow function (see below).need for visualization of the hypopharynx/larynx for biofeedback and/or rehabilitation.sensitivity to velum function for hypernasality and/or suspected nasal regurgitation.sensitivity to increased difficulty with swallowing over the course of a bottle feeding, breastfeeding, or meal, secondary to suspected fatigue.In addition to the general indications for instrumental evaluation, the following indications are specific to FEES: If there are clinical indications for a laryngoscopy evaluation (e.g., hoarse voice, pain on swallowing), the SLP may consider consulting with a physician regarding a referral to an otolaryngologist to rule out the possibility of disease in the nasal, pharyngeal, or laryngeal region. FEES is used without concerns of radiation exposure and can be used within therapeutic contexts and for diagnostic therapy to assess current progress and effectiveness of therapy. FEES may be recommended regardless of setting (e.g., hospital, skilled nursing facility). FEES may be conducted by a speech-language pathologist (SLP), a physician, or collaboratively together. Flexible endoscopic evaluation of swallowing (FEES), sometimes also called fiber-optic endoscopic evaluation of swallowing, is a portable procedure that may be completed in outpatient clinic space or at bedside by passing an endoscope transnasally (Langmore et al., 1988).
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