VFSS and FEES: what to expect from swallowing assessments

A videofluoroscopic swallowing study uses moving X-ray images while a person receives food or drinks containing contrast. A flexible endoscopic evaluation of swallowing uses a thin camera passed through the nose to view the throat. Known as VFSS and FEES, these assessments reveal different aspects of swallowing. Neither is the best choice for everyone: the team considers the clinical question, the person's circumstances and the service's resources.

If you have been referred, understanding these differences can help you discuss the appointment. This article brings together what commonly happens, what each method cannot show and what to confirm before travelling. It does not provide a way to choose an assessment yourself or instructions for repeating swallowing tests during a meal.

Why might a test complement a clinical assessment?

A clinical assessment combines history, observations and information about daily life. Instrumental assessment allows the team to examine internal structures and events that are not visible simply by watching someone eat. Whether that investigation is needed depends on the question to be answered; it is not an automatic step for every referral. ASHA describes how clinical and instrumental assessments relate.

The test does not replace discussion about independence, nutrition, hydration, medication and care goals. An image answers specific questions, while follow-up brings that information together with everyday needs. For the wider care pathway, read about assessment and follow-up with a speech-language professional.

What usually happens during VFSS?

The person is positioned so the equipment can record moving images. Food or drinks prepared with contrast make their passage more visible. The team observes the samples selected for that assessment; this is not a challenge in which you must swallow quickly or finish everything. The Cambridge University Hospitals VFSS leaflet describes one service's experience. Its local instructions should not be treated as universal rules.

Images can show the oral and pharyngeal phases and the initial part of the oesophagus, depending on the protocol. This is not a complete examination of the oesophagus. Questions involving other areas or conditions may require further investigation. ASHA's VFSS reference explains the method's scope.

Before attending, tell the service about difficulty sitting, transferring or maintaining a position. Ask about access, transport and the assistance you may need. Check whether to bring usual utensils or dentures as well. These details help organise the visit without assuming that every service uses identical equipment or follows the same sequence.

What usually happens during FEES?

A thin endoscope passes through the nose to provide a view of the pharyngeal and laryngeal area. FEES does not use radiation and may be performed in different settings, including at the bedside where that option is available. The team explains how the instrument will be placed and what is planned. Cambridge University Hospitals' FEES information describes the experience and communication of findings.

Secretions and residue can be observed before and after a swallow. During swallowing, there is a brief loss of the view called white-out: the camera does not continuously show the whole moment of passage. FEES also does not directly assess the oral or oesophageal phases. These limitations are described in ASHA's FEES reference.

Tell the team if you are worried about the instrument passing through your nose or have had uncomfortable experiences with similar procedures. Ask how to signal discomfort or request a pause. Discussing this helps you participate in the assessment; you do not need to hide discomfort for the appointment to be useful.

A comparison to discuss with the team

The methods can complement each other. A limitation does not make a test useless: it defines which questions the recording can answer. Protocols, availability and team membership differ between services and countries. Professional rules from a foreign institution do not automatically determine how care is organised in Brazil or in your local service.

Confirm preparation with your service

There is no single fasting, eating or medication instruction that applies to both tests and everyone having them. When booking, ask for instructions for your own appointment and check what to do if the date changes. Do not stop medication on your own initiative. If anything is unclear, contact the service and the professional responsible for the prescription before changing your routine.

• Do I need to change meal times or fast? What specific instruction applies to me?
• How should I organise medication that day? Who can clarify a dose or timing question?
• Can someone accompany me? Is assistance available for transfers, wheelchair access or other mobility needs?
• Should I bring utensils, dentures, previous reports or information about my current plan?
• Which phone number or contact channel should I use if my health changes or a question arises before the test?

Tell the service about possible pregnancy, previous reactions to contrast and allergies. For nasal instrumentation, report nasal conditions and a history of bleeding. This gives the team information to assess the procedure; it is not a home checklist of contraindications. Guy's and St Thomas' VFSS information discusses radiation, contrast and information relevant to the service.

Risks and discomfort: questions to ask

VFSS involves X-ray exposure and considerations related to contrast and the possibility of material entering the airway during the samples. With FEES, nasal passage may cause discomfort or bleeding; risks are not zero. UCLH explains the FEES experience and possible complications.

Ask which considerations matter in your circumstances, how your tolerance will be monitored and what to do if symptoms appear after leaving. You do not need to memorise percentages or compare isolated risks online. The conversation should relate the information the team hopes to obtain to your circumstances and preferences. If a consent form includes an unfamiliar term, ask for a plain-language explanation.

Results are a sample, not general clearance

The recording shows what happened under the conditions tested. Amounts, positioning, available time, fatigue and materials offered may differ from a meal at home. ASHA describes sampling limitations of VFSS; FEES also answers questions within the observed context. An apparently favourable result is not unrestricted clearance for every food, drink or situation.

When receiving the report, ask for the findings to be connected to an individual written plan. A caregiver should not interpret a scale or number as an independent diagnosis. If the document and verbal guidance seem different, clarify them with the team before trying to fill in missing instructions yourself.

• What question led to the test, and what did it clarify?
• What was tested and what was not observed? Were there relevant limitations?
• What is the everyday plan, including food, hydration and medication?
• Who will follow up, when is the next appointment and how should difficulties be reported?
• Can I receive the report and instructions to share with people providing care?

For questions about exercises or remote appointments, read about exercises and individual assessment and the limits of telemedicine for dysphagia. These involve decisions that a test alone does not resolve.

While waiting and after the appointment

Write down questions, changes you notice and difficulties following your existing plan. Do not try to provoke symptoms for a recording or perform a water test to check the result. Persistent signs or deterioration need contact with a professional; do not rely only on the next scheduled date. The NHS describes signs that require healthcare attention.

An emergency involving blocked breathing requires immediate help through the local emergency service, without waiting for an assessment or report. See the dedicated article on choking and warning signs. For changes requiring professional assessment, read when to seek help for swallowing difficulty.

References

• ASHA — Videofluoroscopic Swallow Study.
• ASHA — Flexible Endoscopic Evaluation of Swallowing.
• ASHA — Adult Dysphagia.
• CUH — Videofluoroscopy swallow study.
• CUH — Fibreoptic Endoscopic Evaluation of Swallowing.
• Guy's and St Thomas' — Videofluoroscopy to assess swallowing.
• UCLH — Having FEES and VLE.
• NHS — Swallowing problems.