Dr. Aviva Fliker North ENT Otolaryngology Toronto

What is Flexible Endoscopic Evaluation of Swallowing (FEES)?

A Flexible Endoscopic Evaluation of Swallowing (FEES) is an instrumental swallowing assessment used to evaluate how safely and effectively a person swallows food, liquids, medication, and saliva. During the procedure, a thin flexible endoscope is passed gently through the nose to allow an Ear, Nose & Throat (ENT) specialist to view the throat structures while the speech-language pathologist (SLP) evaluates swallowing function in real time.

During the assessment, the patient consumes different food and liquid consistencies, often dyed for visibility, while the clinician observes swallowing function. Recommendations may then be made regarding:

Diet texture and fluid consistency
Safe swallowing strategies
Rehabilitation exercises
Need for further assessment or treatment

Why did my doctor refer me for this exam?

Your doctor may have referred you for FEES due to the following concerns:

Coughing or choking during eating or drinking
Wet or gurgly vocal quality after swallowing
Recurrent chest infections or pneumonia
Suspected aspiration or silent aspiration
Difficulty managing saliva or oral secretions
Complaints of food sticking in the throat

Unexplained weight loss or dehydration
Prolonged mealtimes or reduced oral intake
Neurological conditions affecting swallowing (e.g., stroke, Parkinson’s disease, ALS, brain injury)
Head and neck cancer or post-surgical changes
Tracheostomy
Voice or airway concerns impacting swallowing
Need to assess tolerance of different food or liquid consistencies
Need for objective assessment following a bedside swallowing evaluation
Monitoring progress or effectiveness of dysphagia treatment strategies

Why is this exam not covered by OHIP?

Several Ontario hospitals offer limited outpatient swallowing assessments that are covered by OHIP. Typically, they offer an exam called a Videofluoroscopic Swallow Study (VFSS), also known as a Modified Barium Swallow Study (MBSS). This is an X-ray swallowing assessment used to evaluate how food and liquid move through the mouth and throat during swallowing.

Due to limited availability, wait times for this exam can be lengthy.

We offer the FEES exam in clinic as an expedited alternative to VFSS (when appropriate). Unfortunately, OHIP funding is not currently available for this examination.

Can I be reimbursed by my extended health benefits?

Yes, you may submit the invoices for your exam to your extended health benefits provider under the category of speech-language pathology or speech therapy. The receipts provided will include the therapist’s registration number and all information required for reimbursement.

However, every extended health benefits plan is unique, so we recommend consulting directly with your insurance provider regarding coverage eligibility.

Frequently Asked Questions

Here are a few questions answered to get to know the process better. Feel free to email us if you have further questions.

No. You will be awake, seated upright, and eating/drinking during the assessment.

We do not typically use numbing because it can affect swallowing function. However, most patients tolerate the exam very well.

No. There may be mild discomfort when the scope is initially passed through the nose, but the exam is generally very well tolerated.

Please expect the appointment to take approximately 1.5 hours from start to finish. The endoscopic portion itself typically lasts between 5–20 minutes.