REFERENCE · DIAGNOSTIC TECHNIQUE

FEES and Videofluoroscopy

Clinician-focused educational reference. Swallowing assessment requires appropriate training, consent and an individual safety plan. These are not home tests.

Purpose and Suitability
Anatomy and Physiology
Preparation and Safety
Performing the Assessment
Interpreting Findings
Explaining the Result
Evidence and Limitations
Media and Accessibility
Research and Sources

Purpose and Suitability

Use an instrumental study to answer a defined swallowing-physiology or safety question. It may demonstrate impairment or preserved performance; neither FEES nor VFSS independently diagnoses FND.

FEES: Flexible endoscopic evaluation of swallowing. VFSS: Videofluoroscopic swallow study, also called a modified barium swallow study.

Choose the study around the question, clinical stability, access and local expertise rather than treating the two methods as interchangeable.

Anatomy and Physiology

FEES views the throat and larynx through a nasal endoscope. It does not show oral or oesophageal phases, and reflected light obscures the exact swallow moment: the “white-out.” [3]

VFSS uses moving X-rays and contrast to view oral, pharyngeal and upper oesophageal function during sampled swallows. It can show when material enters the airway. [4]

Residue: Material left after a swallow. Penetration: Material entering the laryngeal airway but remaining above the vocal folds.

These observations describe physiology, not a direct FND brain mechanism.

Preparation and Safety

Explain the question, burdens and alternatives; obtain procedure-specific consent. Use trained staff, local protocols and an appropriate response plan for complications. This guide does not teach endoscope insertion or radiological technique.

FEES selection needs attention to nasal obstruction or trauma, bleeding risk, movement that prevents safe examination and tolerance. VFSS selection needs attention to positioning, medical stability and safe administration of contrast. [3][4]

Keep a way to communicate discomfort available. Stop for withdrawn consent or an adverse change. Record untested conditions instead of extending intake merely to obtain a dramatic demonstration.

Performing the Assessment

State the specific question, such as secretion management, airway entry, bolus clearance or the effect of an already considered strategy.
Review previous findings and establish a clinician-selected sampling plan. Do not transfer a generic food sequence from this educational page into clinical care.
During the study, record the relevant anatomy, tested conditions, observations and tolerance using the service’s validated reporting methods.
Distinguish a directly seen event from an inference or an interval obscured by the method.
Explain what was and was not tested, then give a practical intake and follow-up plan.

These documentation prompts accompany specialist protocols; they are not a new validated instrument. [3][4]

FEES

A flexible endoscope evaluates pharyngeal swallowing and airway protection. Findings can identify impairment or preserved function for tested conditions. This is a differential and safety investigation, not an independent positive test for functional dysphagia. [1][2]

Videofluoroscopic swallowing study

Moving X-ray images assess bolus movement and aspiration during selected swallows. The study can identify structural or physiological problems and guide safe interpretation of symptoms. Normal sampled swallows do not automatically establish a functional diagnosis. [1][2]

Interpreting Findings

Finding or limit	What to document
Airway entry or residue	Tested material, timing, clearance, response and implications for the individual plan.
Preserved sampled function	Exactly which conditions were demonstrated; avoid general clearance of every meal.
FEES white-out	Interpret pre- and post-swallow observations with the method’s visibility limit.
Brief VFSS sample	Radiation and sampling constraints can limit representation of fatigue or usual meals.
Unanswered oesophageal question	Consider the appropriate gastroenterology pathway; neither study replaces every oesophageal investigation.

FEES can support bedside and longer sampling without radiation; VFSS provides a dynamic view but may not reproduce ordinary food, posture or meal duration. These method differences guide selection rather than prove one is universally superior. [3][4]

An abnormal finding can coexist with functional symptoms. A normal sample still requires a coherent diagnosis and an account of the person’s daily difficulty.

Explaining the Result

Authored example:

“This study shows what happened with the swallows we tested. It helps us plan safer and more manageable intake. It does not, on its own, explain every symptom or tell us how a whole meal works for you.”

Use the images only with consent, explain the key observation in ordinary language and provide an accessible written plan.

Evidence and Limitations

ASHA’s sources describe professional procedures and their limitations across swallowing disorders; they are not FND diagnostic-accuracy trials. No universal sensitivity or specificity for functional dysphagia is assigned here. [2][3][4]

Do not label a test “negative for FND.” Its result addresses selected swallowing questions, which then inform the broader formulation.

Media and Accessibility

Use a labelled diagram comparing each method’s field of view. Any real instrumental segment needs specific consent, removal of identifying information and qualified interpretation. Describe the white-out and sampled nature of imaging in captions. Do not arrange a risky food trial for filming. Provide a transcript and static alternative. No media is supplied.

Research and Sources

Citation	Full citation
[1]	Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. Journal of Neurology, Neurosurgery & Psychiatry. 2021;92(10):1112–1125. FND-CIT-0025. https://doi.org/10.1136/jnnp-2021-326767
[2]	American Speech-Language-Hearing Association. Adult Dysphagia. Practice Portal. Source. Accessed September 19, 2026. FND-CIT-0115.
[3]	American Speech-Language-Hearing Association. Flexible Endoscopic Evaluation of Swallowing (FEES). Practice Portal. Procedure guidance. Accessed October 3, 2026. FND-CIT-0250.
[4]	American Speech-Language-Hearing Association. Videofluoroscopic Swallow Study (VFSS). Practice Portal. Procedure guidance. Accessed October 3, 2026. FND-CIT-0251.